Healthcare Provider Details

I. General information

NPI: 1497688659
Provider Name (Legal Business Name): DAYLENE ROSE WELCH PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10511 19TH AVE SE STE B
EVERETT WA
98208-4279
US

IV. Provider business mailing address

6913 187TH PL SW
LYNNWOOD WA
98037-4110
US

V. Phone/Fax

Practice location:
  • Phone: 425-357-8885
  • Fax:
Mailing address:
  • Phone: 425-350-6328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA.P1.70122957
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: