MEDICARE: CAPSTONE THERAPY, LLC

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	2377	OK

General Provider Information

NPI Number	:	1346631587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPSTONE THERAPY, LLC

Provider Business Mailing Address
First Line	:	9810 E 42ND ST
Second Line	:	SUITE 226
City	:	TULSA
State	:	OK
Zip	:	74146-3653
Country	:	US
Telephone Number	:	918-292-8886
Fax Number	:

Provider Business Practice Location Address
First Line	:	9810 E 42ND ST
Second Line	:	SUITE 226
City	:	TULSA
State	:	OK
Zip	:	74146-3653
Country	:	US
Telephone Number	:	918-292-8886
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARK RANDAL WINKELMANN
Credential	:	PT
Telephone Number	:	918-292-8886

Provider Enumeration Date	:	02/10/2015
Last Update Date	:	11/20/2015

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Directions to “CAPSTONE THERAPY, LLC ” Practice Location

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