MEDICARE: JEAN WELIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA18858	FL

General Provider Information

NPI Number	:	1245362805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN WELIN

Provider Business Mailing Address
First Line	:	2115 N 49TH AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-4039
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8612 GRIFFIN RD
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33328-3719
Country	:	US
Telephone Number	:	954-252-8900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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