Provider Demographics
NPI:1730259060
Name:WELKER, ERIC JAMES (ATC PTA)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JAMES
Last Name:WELKER
Suffix:
Gender:M
Credentials:ATC PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1067 PEGASUS STREET
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807
Mailing Address - Country:US
Mailing Address - Phone:714-283-2298
Mailing Address - Fax:
Practice Address - Street 1:2501 CHERRY AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-2031
Practice Address - Country:US
Practice Address - Phone:562-595-5159
Practice Address - Fax:562-595-7839
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT8297225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant