Basic Information
| Provider Information | |||||||||
| NPI: | 1730458563 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELCH | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | AMY WELCH | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | WELCH | ||||||||
| OtherFirstName: | AMY | ||||||||
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| OtherCredential: | AMY WELCH | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 16083 SW UPPER BOONES FERRY RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972247736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002198835 | ||||||||
| FaxNumber: | 5036399699 | ||||||||
| Practice Location | |||||||||
| Address1: | 509 OLIVE WAY STE 1011 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981011710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2066234570 | ||||||||
| FaxNumber: | 2066234574 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2011 | ||||||||
| LastUpdateDate: | 02/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 11078 | NC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT60438790 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0328107 | 01 | WA | WA L&I | OTHER | 0328110 | 01 | WA | WA L&I | OTHER | 0328112 | 01 | WA | WA L&I | OTHER | 0328117 | 01 | WA | WA L&I | OTHER | 0328113 | 01 | WA | WA L&I | OTHER | 0328114 | 01 | WA | WA L&I | OTHER | 0328116 | 01 | WA | WA L&I | OTHER | 0328119 | 01 | WA | WA L&I | OTHER | 1730458563 | 05 | WA | MEDICAID | 0328118 | 01 | WA | WA L&I | OTHER | 0328115 | 01 | WA | WA L&I | OTHER |