Provider Demographics
NPI:1053702373
Name:WELCH, ELIZABETH (DPT, ATC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2596 BAIRD RD
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2333
Mailing Address - Country:US
Mailing Address - Phone:585-249-7243
Mailing Address - Fax:
Practice Address - Street 1:2596 BAIRD RD
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2333
Practice Address - Country:US
Practice Address - Phone:585-249-7243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3536225100000X
NY040247225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist