Provider Demographics
NPI:1598726515
Name:WELCH, DEANNA K (MPT)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:K
Last Name:WELCH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:DEANNA
Other - Middle Name:K
Other - Last Name:BONDIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:261 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2495
Mailing Address - Country:US
Mailing Address - Phone:313-745-1160
Mailing Address - Fax:313-993-8779
Practice Address - Street 1:261 MACK AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-1160
Practice Address - Fax:313-993-8779
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist