MEDICARE: JACQUELINE RENEE WINTER DPT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist		MO

General Provider Information

NPI Number	:	1093381352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE RENEE WINTER DPT, ATC

Provider Business Mailing Address
First Line	:	407 NW 15P RD
Second Line	:
City	:	CLINTON
State	:	MO
Zip	:	64735-9246
Country	:	US
Telephone Number	:	660-492-3428
Fax Number	:

Provider Business Practice Location Address
First Line	:	8250 N CHURCH RD STE B
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64158-1103
Country	:	US
Telephone Number	:	816-503-8371
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2021
Last Update Date	:	05/27/2021

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