Provider Demographics
NPI:1831754860
Name:WELDY, MICHAEL BENJAMIN (DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BENJAMIN
Last Name:WELDY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 1/2 MISSISSIPPI ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4116
Mailing Address - Country:US
Mailing Address - Phone:925-787-2343
Mailing Address - Fax:
Practice Address - Street 1:1350 E DEVONSHIRE AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-8629
Practice Address - Country:US
Practice Address - Phone:951-925-2571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist