MEDICARE: MR. ADAM CHRISTIAN WACHTER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	29521	CA
2	225100000X	Physical Therapist	OR 6654	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ZZZ66237Z	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1649280132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ADAM CHRISTIAN WACHTER PT

Provider Business Mailing Address
First Line	:	16083 SW UPPER BOONES FERRY RD
Second Line	:	SUITE 300
City	:	TIGARD
State	:	OR
Zip	:	97224-7736
Country	:	US
Telephone Number	:	800-219-8835
Fax Number	:	503-639-9699

Provider Business Practice Location Address
First Line	:	17449 BOONES FERRY RD
Second Line	:	STE. 300
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-6206
Country	:	US
Telephone Number	:	503-635-0844
Fax Number	:	503-638-0812

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	11/13/2012

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