Provider Demographics
NPI:1437847316
Name:WACHTMAN, MATTHEW ADAM (DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ADAM
Last Name:WACHTMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WESTRIDGE DR STE F
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4448
Mailing Address - Country:US
Mailing Address - Phone:502-227-3186
Mailing Address - Fax:
Practice Address - Street 1:209 MADISON ST STE LL2
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2065
Practice Address - Country:US
Practice Address - Phone:703-299-6688
Practice Address - Fax:703-299-3588
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYCP034874T225100000X
390200000X
VA2305216741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program