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NPI Code Detail

MEDICARE: BRAYDON WELCH DPT

MEDICARE: BRAYDON WELCH DPT
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
1225100000XPhysical Therapist5501304332MI

General Provider Information

NPI Number : 1336096502
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRAYDON WELCH DPT
Provider Business Mailing Address
First Line : 22825 ROSEDALE ST
Second Line :
City : SAINT CLAIR SHORES
State : MI
Zip : 48080-3864
Country : US
Telephone Number : 989-460-7843
Fax Number :
Provider Business Practice Location Address
First Line : 43740 GARFIELD RD
Second Line :
City : CLINTON TWP
State : MI
Zip : 48038-1122
Country : US
Telephone Number : 586-228-0270
Fax Number : 586-228-9019
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2026
Last Update Date : 03/16/2026

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