Provider Demographics
NPI:1649280132
Name:WACHTER, ADAM CHRISTIAN (PT)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:CHRISTIAN
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 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:17449 BOONES FERRY RD
Practice Address - Street 2:STE. 300
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-6206
Practice Address - Country:US
Practice Address - Phone:503-635-0844
Practice Address - Fax:503-638-0812
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29521174400000X
OROR 6654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500643799Medicaid
CAZZZ66237ZOtherBLUE SHIELD
CAQ27603Medicare UPIN
CAWPT29521BMedicare ID - Type Unspecified
ORR165276Medicare PIN