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Individual
MR. JUSTIN MICHAEL WELCH
Active
Individual
MR. JUSTIN MICHAEL WELCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
17635
MA
261QR0400X
Rehabilitation Clinic/Center
Primary
0010078
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010078
STATE OF COLORADO LICENSE
CO
01
—
11667806
CAQH
CO
01
—
11667806
CAQH
MA
01
—
17635
P.T. LICENSE NUMBER
MA
Enumeration date
07/31/2006
Last updated
02/26/2015
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