MEDICARE: MR. WILLIAM ODES WELCHER PTA

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

General Provider Information

NPI Number	:	1841495322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM ODES WELCHER PTA

Provider Business Mailing Address
First Line	:	4122 LINCOLN WAY
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-4006
Country	:	US
Telephone Number	:	712-251-3308
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 W 19TH ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51103-2333
Country	:	US
Telephone Number	:	712-277-4260
Fax Number	:

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

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	07/08/2007

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