Healthcare Provider Details

I. General information

NPI: 1780626416
Provider Name (Legal Business Name): WADE BATCHELOR PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N CENTER ST
NEW BOSTON TX
75570-2918
US

IV. Provider business mailing address

303 N CENTER ST
NEW BOSTON TX
75570-2918
US

V. Phone/Fax

Practice location:
  • Phone: 903-628-7700
  • Fax: 903-628-7701
Mailing address:
  • Phone: 903-628-7700
  • Fax: 903-628-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5439
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1125979
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: