Provider Demographics
NPI:1932306511
Name:WELK, ROBERT JOHN JR
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:WELK
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 N LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3028
Mailing Address - Country:US
Mailing Address - Phone:402-461-4931
Mailing Address - Fax:
Practice Address - Street 1:223 E 14TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3200
Practice Address - Country:US
Practice Address - Phone:402-461-4931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC15405225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter