Provider Demographics
NPI:1194369645
Name:BAUCHERT, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BAUCHERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11612 NE 103RD ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-3538
Mailing Address - Country:US
Mailing Address - Phone:423-718-5317
Mailing Address - Fax:
Practice Address - Street 1:1015 OCEAN BEACH HWY STE 16
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4098
Practice Address - Country:US
Practice Address - Phone:360-501-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62896225100000X
WAPT61012542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist