MEDICARE: REGINALD EDWARD WELCH PT015800

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	PT015800	GA

General Provider Information

NPI Number	:	1568119493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINALD EDWARD WELCH PT015800

Provider Business Mailing Address
First Line	:	2631 WEATHERSTONE CIR SE
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30094-2015
Country	:	US
Telephone Number	:	770-841-9353
Fax Number	:

Provider Business Practice Location Address
First Line	:	4223 HIGHWAY 42
Second Line	:
City	:	CONLEY
State	:	GA
Zip	:	30288-2141
Country	:	US
Telephone Number	:	404-366-2900
Fax Number	:

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

Provider Enumeration Date	:	03/10/2022
Last Update Date	:	03/10/2022

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