Provider Demographics
NPI:1609348937
Name:WACHTER, WILLIAM JESSE (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JESSE
Last Name:WACHTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8565 N SILVERY LN STE 401
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-4518
Mailing Address - Country:US
Mailing Address - Phone:313-359-9595
Mailing Address - Fax:
Practice Address - Street 1:8565 N SILVERY LN STE 401
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-4518
Practice Address - Country:US
Practice Address - Phone:313-359-9595
Practice Address - Fax:313-359-9585
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist