MEDICARE: MR. KENNETH O WELK PT

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	11-00645	KS

General Provider Information

NPI Number	:	1922084318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH O WELK PT

Provider Business Mailing Address
First Line	:	4701 PORTWEST CIR
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67204-2356
Country	:	US
Telephone Number	:	316-832-9327
Fax Number	:

Provider Business Practice Location Address
First Line	:	728 N EMPORIA ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67214-3708
Country	:	US
Telephone Number	:	316-263-1952
Fax Number	:	316-263-4384

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	07/08/2007

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Directions to “ MR. KENNETH O WELK PT” Practice Location

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