MEDICARE: MATTHEW WINES DPT

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	PT61232414	WA

General Provider Information

NPI Number	:	1770230047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW WINES DPT

Provider Business Mailing Address
First Line	:	15623 1ST AVE S STE C
Second Line	:
City	:	BURIEN
State	:	WA
Zip	:	98148-1292
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15623 1ST AVE S STE C
Second Line	:
City	:	BURIEN
State	:	WA
Zip	:	98148-1292
Country	:	US
Telephone Number	:	206-444-6320
Fax Number	:

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

Provider Enumeration Date	:	03/07/2022
Last Update Date	:	03/07/2022

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Directions to “ MATTHEW WINES DPT” Practice Location

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