MEDICARE: MR. KRISTOPHER WAYNE WINDERS

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	6708	KY

General Provider Information

NPI Number	:	1659306678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KRISTOPHER WAYNE WINDERS

Provider Business Mailing Address
First Line	:	162 OLD TODDS RD
Second Line	:	#260
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1336
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	162 OLD TODDS RD
Second Line	:	#260
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1336
Country	:	US
Telephone Number	:	859-654-0119
Fax Number	:	859-652-3903

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	05/10/2016

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