MEDICARE: LAURA WINTERS PTA

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	225200000X	Physical Therapy Assistant	2009015802	MO

General Provider Information

NPI Number	:	1952708703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA WINTERS PTA

Provider Business Mailing Address
First Line	:	1260 N JOHNSON ST
Second Line	:
City	:	KAHOKA
State	:	MO
Zip	:	63445-1100
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1260 N JOHNSON ST
Second Line	:
City	:	KAHOKA
State	:	MO
Zip	:	63445-1100
Country	:	US
Telephone Number	:	660-727-9024
Fax Number	:	866-581-7732

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

Provider Enumeration Date	:	11/21/2014
Last Update Date	:	11/21/2014

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Directions to “ LAURA WINTERS PTA” Practice Location

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