Individual
BRYAN PAUL WELDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
27 S WESTERN AVE STE B, CARPENTERSVILLE, IL 60110-1715
(630) 296-2222
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2222
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070011738
IL
225100000X
Physical Therapist
6519024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00485940
MEDICARE WI
WI
05
—
33874990001
—
IL
01
—
40462600
MEDICAID WI
WI
01
—
IL6237010
MEDICARE
IL
01
—
IL6238010
MEDICARE
IL
01
—
IL6697011
MEDICARE
IL
Enumeration date
05/25/2006
Last updated
03/06/2015
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