Healthcare Provider Details

I. General information

NPI: 1841402062
Provider Name (Legal Business Name): KRISTEN E WELDIE ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 COMMERCE DR
FORT WASHINGTON PA
19034-2618
US

IV. Provider business mailing address

2126 ALEXANDER DR
NORRISTOWN PA
19403-2602
US

V. Phone/Fax

Practice location:
  • Phone: 215-641-0700
  • Fax: 215-641-0637
Mailing address:
  • Phone: 610-630-8414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT003386
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier991391
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerNATA CERTIFICATION
# 2
IdentifierRT003386
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerSTATE LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: