Healthcare Provider Details

I. General information

NPI: 1356818116
Provider Name (Legal Business Name): JAMES RAYMOND WINKELER PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12335 W BEND DR
SAINT LOUIS MO
63128-2160
US

IV. Provider business mailing address

3515 HARTFORD ST
SAINT LOUIS MO
63118-2012
US

V. Phone/Fax

Practice location:
  • Phone: 877-931-1590
  • Fax:
Mailing address:
  • Phone: 314-323-7818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2018026224
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: