1295132876 NPI number — DR. SARAH MARIE BUSENTIZ WACHTEL DPT, PT, OCS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295132876 NPI number — DR. SARAH MARIE BUSENTIZ WACHTEL DPT, PT, OCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WACHTEL
Provider First Name:
SARAH
Provider Middle Name:
MARIE BUSENTIZ
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT, PT, OCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295132876
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6455 MACHINE ST.
Provider Second Line Business Mailing Address:
BUILDING 2501
Provider Business Mailing Address City Name:
ABERDEEN PROVING GROUND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-278-9990
Provider Business Mailing Address Fax Number:
877-811-2184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6455 MACHINE S
Provider Second Line Business Practice Location Address:
BUILDING 2501
Provider Business Practice Location Address City Name:
ABERDEEN PROVING GROUND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21005-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-278-9990
Provider Business Practice Location Address Fax Number:
877-811-2184
Provider Enumeration Date:
11/26/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  25324 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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