Provider Demographics
NPI:1174916811
Name:WELTY, DANIEL (MS,LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:WELTY
Suffix:
Gender:M
Credentials:MS,LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8428 KIRKLIN CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-9171
Mailing Address - Country:US
Mailing Address - Phone:317-407-9101
Mailing Address - Fax:
Practice Address - Street 1:5255 E STOP 11 RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6340
Practice Address - Country:US
Practice Address - Phone:317-781-1133
Practice Address - Fax:317-528-7099
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002776A2255A2300X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer