MEDICARE: KELLI MARIE WELSHEIMER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	10854	OH
2	225100000X	Physical Therapist	23848	FL

General Provider Information

NPI Number	:	1215115043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI MARIE WELSHEIMER PT

Provider Business Mailing Address
First Line	:	5600 SPRING PARK RD
Second Line	:	SUITE 100
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-5988
Country	:	US
Telephone Number	:	904-399-5959
Fax Number	:

Provider Business Practice Location Address
First Line	:	5600 SPRING PARK RD
Second Line	:	SUITE 100
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-5988
Country	:	US
Telephone Number	:	904-399-5959
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	09/08/2008

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