Provider Demographics
NPI:1689681975
Name:WELCH, NICHOLAS GUY (PT)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:GUY
Last Name:WELCH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 S ROCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-9443
Mailing Address - Country:US
Mailing Address - Phone:480-577-1012
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ69704Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID#