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General NPI Number Information
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NPI Number | 1538504758
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Entity Type | Individual
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Provider Name | BRIAN EDWARD WELCH MED, ATC, LAT, PTA
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Gender | Male
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Dates
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Enumeration Date | 05/01/2013
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Last Update Date | 03/04/2014
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Provider Practice Location Address
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Address Line | 136 TEAGUE SPECIAL EVENTS CTR ACU BOX 27916
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City | ABILENE
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State | TX
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Zip | 79699-7916
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Country | US
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Telephone | 325-674-2506
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Fax | 325-674-4822
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Provider Business Mailing Address
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Address Line | 136 TEAGUE SPECIAL EVENTS CTR ACU BOX 27916
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City | ABILENE
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State | TX
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Zip | 79699-7916
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Country | US
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Telephone | 325-674-2506
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Fax | 325-674-4822
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2008003318
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT5081
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2011008024
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License Number State | MO
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