Provider Demographics
NPI:1578579231
Name:WELCH PHYSICAL THERAPY AND SPORTS MEDICINE, LLC
Entity Type:Organization
Organization Name:WELCH PHYSICAL THERAPY AND SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:GUY
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-814-8222
Mailing Address - Street 1:3011 S LINDSAY RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-4332
Mailing Address - Country:US
Mailing Address - Phone:480-814-8222
Mailing Address - Fax:480-814-8225
Practice Address - Street 1:3011 S LINDSAY RD
Practice Address - Street 2:SUITE 114
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-4332
Practice Address - Country:US
Practice Address - Phone:480-814-8222
Practice Address - Fax:480-814-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ69703Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER