Provider Demographics
NPI:1235289133
Name:WALDCHEN, ROBERT E (PT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:WALDCHEN
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 1:1707 OAK ST
Mailing Address - Street 2:D
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2125
Mailing Address - Country:US
Mailing Address - Phone:406-587-8446
Mailing Address - Fax:406-587-0898
Practice Address - Street 1:1707 OAK ST
Practice Address - Street 2:D
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2125
Practice Address - Country:US
Practice Address - Phone:406-587-8446
Practice Address - Fax:406-587-0898
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2208MT2251X0800X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222878657OtherEMPLOYER IDENTIFICATION #
NJ222878657OtherEMPLOYER IDENTIFICATION #