Individual
KELLY MARIE WACHTL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
4805 NE GLISAN ST, INPATIENT REHABILITATION SERVICES, PORTLAND, OR 97213-2933
(503) 215-6059
Mailing address
6601 N DELAWARE AVE, PORTLAND, OR 97217-5309
(503) 545-6971
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5255
OR
Other
Enumeration date
05/08/2007
Last updated
07/08/2007
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