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NPI Code Detail

MEDICARE: DOUGLAS WINZENBURG PT, DPT, ATC

MEDICARE:   DOUGLAS  WINZENBURG  PT, DPT, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer
2390200000XStudent in an Organized Health Care Education/Training Program
3261QP2000XPhysical Therapy Clinic/Center2496ND

General Provider Information

NPI Number : 1144730045
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS WINZENBURG PT, DPT, ATC
Provider Business Mailing Address
First Line : 3509 MERIDIAN DR
Second Line :
City : BISMARCK
State : ND
Zip : 58504-8533
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3921 LOCKPORT ST
Second Line :
City : BISMARCK
State : ND
Zip : 58503-5541
Country : US
Telephone Number : 701-751-3128
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2017
Last Update Date : 06/21/2021

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