Provider Demographics
NPI:1902369614
Name:WELCH, CARLY (DPT)
Entity Type:Individual
Prefix:MS
First Name:CARLY
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 932184
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-2184
Mailing Address - Country:US
Mailing Address - Phone:800-699-9395
Mailing Address - Fax:
Practice Address - Street 1:6407 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76132-2777
Practice Address - Country:US
Practice Address - Phone:817-423-5611
Practice Address - Fax:817-423-5611
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1243203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist