Basic Information
| Provider Information | |||||||||
| NPI: | 1043331051 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELSH III | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 POMPERAUG OFFICE PARK | ||||||||
| Address2: | |||||||||
| City: | SOUTHBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064882288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032641735 | ||||||||
| FaxNumber: | 2032649251 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 POMPERAUG OFFICE PARK | ||||||||
| Address2: | |||||||||
| City: | SOUTHBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064882288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032641735 | ||||||||
| FaxNumber: | 2032649251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 04/29/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 006463 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 004398203 | 05 | CT | MEDICAID | ANC1153 | 01 | CT | OXFORD HEALTH PLAN | OTHER | OV1301 | 01 | CT | HEALTHNET | OTHER | 080002440CT01 | 01 | CT | BLUE CROSS | OTHER |