Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | 2208MT | MT |
Y | 2251X0800X | Physical Therapist - Orthopedic | 2208MT | MT |
NPI | 1235289133 |
---|---|
Provider Name | Mr. Robert E Waldchen |
First Address | Bozeman, MT 59715-2125 |
Second Address | Bozeman, MT 59715-2125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 01/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
222878657 | EMPLOYER IDENTIFICATION # (01) | NJ |