# MR. JUSTIN MICHAEL WELCH

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1780690768
- **Gender:** Man
- **Credential:** PT, DPT

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 17635 | MA | — |
| 261QR0400X | Rehabilitation Clinic/Center | 0010078 | CO | Yes |

## Other

- **Enumeration date:** 07/31/2006
- **Last updated:** 02/26/2015

## 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 |