Provider Demographics
NPI:1962026823
Name:WACHTER, ANN (PT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:WACHTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6408 TORREY PINES DR
Mailing Address - Street 2:
Mailing Address - City:ASBURY
Mailing Address - State:IA
Mailing Address - Zip Code:52002-9366
Mailing Address - Country:US
Mailing Address - Phone:563-581-7960
Mailing Address - Fax:
Practice Address - Street 1:6408 TORREY PINES DR
Practice Address - Street 2:
Practice Address - City:ASBURY
Practice Address - State:IA
Practice Address - Zip Code:52002-9366
Practice Address - Country:US
Practice Address - Phone:563-581-7960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty