Provider Demographics
NPI:1780626416
Name:BATCHELOR, WADE (PT)
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:
Last Name:BATCHELOR
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 1:303 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75570-2918
Mailing Address - Country:US
Mailing Address - Phone:903-628-7700
Mailing Address - Fax:903-628-7701
Practice Address - Street 1:303 N CENTER ST
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:TX
Practice Address - Zip Code:75570-2918
Practice Address - Country:US
Practice Address - Phone:903-628-7700
Practice Address - Fax:903-628-7701
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT5439225100000X
TX1125979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174702401Medicaid
TX174702401Medicaid
TX00594YMedicare PIN