Provider Demographics
NPI:1275174526
Name:NECHTAN, WOLFGANG KUNO ALEXANDER (LMT)
Entity Type:Individual
Prefix:
First Name:WOLFGANG
Middle Name:KUNO ALEXANDER
Last Name:NECHTAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:TIMOTHY
Other - Middle Name:LEE ALEXANDER
Other - Last Name:WELBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:3305 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2234
Mailing Address - Country:US
Mailing Address - Phone:360-693-8064
Mailing Address - Fax:
Practice Address - Street 1:3305 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2234
Practice Address - Country:US
Practice Address - Phone:360-693-8064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60433612OtherLICENSE