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General NPI Number Information
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NPI Number | 1689147720
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Entity Type | Individual
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Provider Name | SHAYNE BARBARA WELCH PT
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Gender | Female
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 40 SKOKIE BLVD STE 110
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City | NORTHBROOK
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State | IL
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Zip | 60062-1614
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Country | US
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Telephone | 224-407-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 639 LINCOLN AVE
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City | WINNETKA
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State | IL
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Zip | 60093-2345
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Country | US
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Telephone | 312-286-1506
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070011992
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License Number State | IL
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