MEDICARE: MR. EDWARD LEE WELCH PHYSICAL THERAPIST

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	PT008866L	PA

General Provider Information

NPI Number	:	1912987991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD LEE WELCH PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	602 W DUBOIS AVE
Second Line	:
City	:	DU BOIS
State	:	PA
Zip	:	15801-3905
Country	:	US
Telephone Number	:	814-375-6830
Fax Number	:	814-375-6832

Provider Business Practice Location Address
First Line	:	602 W DUBOIS AVE
Second Line	:
City	:	DU BOIS
State	:	PA
Zip	:	15801-3905
Country	:	US
Telephone Number	:	814-375-6830
Fax Number	:	814-375-6832

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/08/2007

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