MEDICARE: LESLIE WINTERS P.T.

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
1	225100000X	Physical Therapist	117019	MO

General Provider Information

NPI Number	:	1366458416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE WINTERS P.T.

Provider Business Mailing Address
First Line	:	120 S JOHNSON ST
Second Line	:
City	:	KAHOKA
State	:	MO
Zip	:	63445-1657
Country	:	US
Telephone Number	:	660-727-2722
Fax Number	:	660-727-2725

Provider Business Practice Location Address
First Line	:	120 S JOHNSON ST
Second Line	:
City	:	KAHOKA
State	:	MO
Zip	:	63445-1657
Country	:	US
Telephone Number	:	660-727-2722
Fax Number	:	660-727-2725

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/06/2020

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