Provider Demographics
NPI:1922084318
Name:WELK, KENNETH O (PT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:O
Last Name:WELK
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 1:4701 PORTWEST CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67204-2356
Mailing Address - Country:US
Mailing Address - Phone:316-832-9327
Mailing Address - Fax:
Practice Address - Street 1:728 N EMPORIA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3708
Practice Address - Country:US
Practice Address - Phone:316-263-1952
Practice Address - Fax:316-263-4384
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-00645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist