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General NPI Number Information
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NPI Number | 1376206326
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Entity Type | Individual
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Provider Name | ISSIAC WINGERTER PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 10/18/2021
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 12926 SE KENT KANGLEY RD
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City | KENT
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State | WA
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Zip | 98030-7940
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Country | US
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Telephone | 253-216-1041
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 BUTTERFIELD RD STE 1600
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1211
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Country | US
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Telephone | 866-370-8206
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070026309
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License Number State | IL
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