Healthcare Provider Details

I. General information

NPI: 1144143132
Provider Name (Legal Business Name): KATELYN WELCH PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN LEE

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W ELLIOT RD STE 109
TEMPE AZ
85284-1310
US

IV. Provider business mailing address

2949 E INDIGO ST
MESA AZ
85213-5580
US

V. Phone/Fax

Practice location:
  • Phone: 480-374-4341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-015172
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: