MEDICARE: ALICE A. D. WELCH PT, MSPT

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	225100000X	Physical Therapist	003209	KY

General Provider Information

NPI Number	:	1528633013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICE A. D. WELCH PT, MSPT

Provider Business Mailing Address
First Line	:	1905 W HEBRON LN STE 106
Second Line	:
City	:	SHEPHERDSVILLE
State	:	KY
Zip	:	40165-7466
Country	:	US
Telephone Number	:	502-510-1445
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 W HEBRON LN STE 106
Second Line	:
City	:	SHEPHERDSVILLE
State	:	KY
Zip	:	40165-7466
Country	:	US
Telephone Number	:	502-510-1445
Fax Number	:	502-957-1257

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

Provider Enumeration Date	:	05/26/2021
Last Update Date	:	05/26/2021

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