Individual
BRYAN PAUL WELDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
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
Update your record
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