Healthcare Provider Details

I. General information

NPI: 1316748452
Provider Name (Legal Business Name): MICHAELA WELCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 S WABASH AVE STE 100
CHICAGO IL
60616-2491
US

IV. Provider business mailing address

1000 S CLARK ST UNIT 1709
CHICAGO IL
60605-2195
US

V. Phone/Fax

Practice location:
  • Phone: 312-842-4600
  • Fax:
Mailing address:
  • Phone: 708-941-3107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.029032
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: