Healthcare Provider Details

I. General information

NPI: 1649935206
Provider Name (Legal Business Name): KARL WINEK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 HILL ST
WATERTOWN WI
53098-3016
US

IV. Provider business mailing address

1020 HILL ST
WATERTOWN WI
53098-3016
US

V. Phone/Fax

Practice location:
  • Phone: 920-206-4935
  • Fax:
Mailing address:
  • Phone: 920-206-4935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15589-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: