Provider Demographics
NPI:1811023419
Name:WELCH, WILLIAM (MPT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:WELCH
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 W MORELAND BLVD
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES MORELAND FAMILY MEDIC
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2432
Mailing Address - Country:US
Mailing Address - Phone:262-542-9100
Mailing Address - Fax:262-542-7366
Practice Address - Street 1:717 W MORELAND BLVD
Practice Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES MORELAND FAMILY MEDIC
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-2432
Practice Address - Country:US
Practice Address - Phone:262-542-9100
Practice Address - Fax:262-542-7366
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6212024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
68375Medicare PIN