MEDICARE: KRISTEN WELSH P.T., D.P.T.

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	34103	CA

General Provider Information

NPI Number	:	1780867861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN WELSH P.T., D.P.T.

Provider Business Mailing Address
First Line	:	5540 DOYLE ST # J
Second Line	:
City	:	EMERYVILLE
State	:	CA
Zip	:	94608-2502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19933 LAKE CHABOT RD
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-4003
Country	:	US
Telephone Number	:	510-727-2755
Fax Number	:

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

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	12/11/2007

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