Healthcare Provider Details

I. General information

NPI: 1982104485
Provider Name (Legal Business Name): SEAN THOMAS WELSH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2531 OLD ROSEBUD RD
LEXINGTON KY
40509-4574
US

IV. Provider business mailing address

3180 SCOTTISH TRCE
LEXINGTON KY
40509-8544
US

V. Phone/Fax

Practice location:
  • Phone: 859-543-0337
  • Fax:
Mailing address:
  • Phone: 989-331-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007089
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: