Provider Demographics
NPI:1083026439
Name:WINKLE, MATTHEW HAROLD (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:HAROLD
Last Name:WINKLE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:816-226-4011
Mailing Address - Fax:816-524-6115
Practice Address - Street 1:2 E GREGORY BLVD
Practice Address - Street 2:STE 200
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1118
Practice Address - Country:US
Practice Address - Phone:816-926-0222
Practice Address - Fax:816-926-0277
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014027204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
892047OtherOPTUM
MOMA4370077OtherMEDICARE PTAN
50465013OtherBCBS-KC