Provider Demographics
NPI:1619080652
Name:WELCH, JENNIFER LYN (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYN
Last Name:WELCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYN
Other - Last Name:ZULLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3411 36TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-7104
Mailing Address - Country:US
Mailing Address - Phone:253-232-7421
Mailing Address - Fax:
Practice Address - Street 1:7500 SEWARD PARK AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-4247
Practice Address - Country:US
Practice Address - Phone:253-232-7421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT00010198OtherPHYSICAL THERAPIST LICENS