Healthcare Provider Details

I. General information

NPI: 1083026439
Provider Name (Legal Business Name): MATTHEW HAROLD WINKLE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 E GREGORY BLVD STE 200
KANSAS CITY MO
64114-1118
US

IV. Provider business mailing address

8823 PRODUCTION LN
OOLTEWAH TN
37363-6511
US

V. Phone/Fax

Practice location:
  • Phone: 816-926-0222
  • Fax: 816-926-0277
Mailing address:
  • Phone: 816-226-4011
  • Fax: 816-524-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2014027204
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: