Basic Information
| Provider Information | |||||||||
| NPI: | 1720359235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WELCH | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | F. | ||||||||
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| Credential: | MS, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2305 BUCKINGHAM AVE | ||||||||
| Address2: | |||||||||
| City: | HENRICO | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232286030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082722292 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8201 ATLEE RD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | MECHANICSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231161815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045691787 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2012 | ||||||||
| LastUpdateDate: | 01/16/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 0126001125 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.