Healthcare Provider Details

I. General information

NPI: 1124948401
Provider Name (Legal Business Name): VANESSA ANN WELCH PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA ANN SHORTT PTA

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ST. PATRICK'S PLACE
PORT HENRY NY
12974
US

IV. Provider business mailing address

10 ST. PATRICK'S PLACE
PORT HENRY NY
12974
US

V. Phone/Fax

Practice location:
  • Phone: 518-546-7151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number006599-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: