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NPI Code Detail

MEDICARE: BRAD WINTERLE

MEDICARE: BRAD WINTERLE
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
1225200000XPhysical Therapy Assistant2006009940MO

General Provider Information

NPI Number : 1942596531
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRAD WINTERLE
Provider Business Mailing Address
First Line : 845 E MEADOW GARDEN CT
Second Line :
City : NIXA
State : MO
Zip : 65714-7667
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 410 W BENTON ST
Second Line :
City : MONETT
State : MO
Zip : 65708-1608
Country : US
Telephone Number : 417-235-6031
Fax Number : 417-235-3039
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2011
Last Update Date : 06/22/2011

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Directions to “ BRAD WINTERLE ” Practice Location

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