Provider Demographics
NPI:1770678906
Name:WELPOTT, BOBBI (PT)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:
Last Name:WELPOTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 HULEN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-7256
Mailing Address - Country:US
Mailing Address - Phone:817-446-8000
Mailing Address - Fax:
Practice Address - Street 1:3880 HULEN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7256
Practice Address - Country:US
Practice Address - Phone:817-446-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0084262251P0200X
TX10550102251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1770678906Medicaid
GA358833221AMedicaid