Provider Demographics
NPI:1972873214
Name:WACHTER, KASSIDY D
Entity type:Individual
Prefix:
First Name:KASSIDY
Middle Name:D
Last Name:WACHTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:PIERCE
Mailing Address - State:NE
Mailing Address - Zip Code:68767-1405
Mailing Address - Country:US
Mailing Address - Phone:308-750-5923
Mailing Address - Fax:
Practice Address - Street 1:515 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:PIERCE
Practice Address - State:NE
Practice Address - Zip Code:68767
Practice Address - Country:US
Practice Address - Phone:402-329-6228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE951225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant