Healthcare Provider Details

I. General information

NPI: 1336096502
Provider Name (Legal Business Name): BRAYDON WELCH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43740 GARFIELD RD
CLINTON TWP MI
48038-1122
US

IV. Provider business mailing address

22825 ROSEDALE ST
SAINT CLAIR SHORES MI
48080-3864
US

V. Phone/Fax

Practice location:
  • Phone: 586-228-0270
  • Fax: 586-228-9019
Mailing address:
  • Phone: 989-460-7843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501304332
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: