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General NPI Number Information
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NPI Number | 1457950321
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Entity Type | Individual
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Provider Name | JARED VAN WINKLE PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 10/21/2020
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 513 3RD ST SW
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City | WAGNER
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State | SD
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Zip | 57380-9675
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Country | US
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Telephone | 605-384-3611
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Fax |
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Provider Business Mailing Address
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Address Line | 302 E 14TH AVE
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City | TYNDALL
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State | SD
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Zip | 57066-2254
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Country | US
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Telephone | 605-857-0043
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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 | 2117
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License Number State | SD
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