Provider Demographics
NPI:1811087588
Name:WELCH, MELISSA LAGEMAN (PT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LAGEMAN
Last Name:WELCH
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 1:2484 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-2449
Mailing Address - Country:US
Mailing Address - Phone:805-653-8040
Mailing Address - Fax:
Practice Address - Street 1:2895 LOMA VISTA RD
Practice Address - Street 2:STE B
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1572
Practice Address - Country:US
Practice Address - Phone:805-643-4093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist