Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TR0400X | Rehabilitation Psychologist | ||
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003392598 |
---|---|
Provider Name | Joshua Welz |
First Address | Coeur D Alene, ID 83814-2670 |
Second Address | Post Falls, ID 83854 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2018 |
Last Update Date | 19/07/2018 |