Provider Demographics
NPI:1205039377
Name:WINNARD, LARRY L (ATC)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:L
Last Name:WINNARD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7421 N. W. 27TH
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008
Mailing Address - Country:US
Mailing Address - Phone:405-414-5790
Mailing Address - Fax:405-789-1662
Practice Address - Street 1:5300 N. W. 50TH
Practice Address - Street 2:
Practice Address - City:OKLA. CITY
Practice Address - State:OK
Practice Address - Zip Code:73122
Practice Address - Country:US
Practice Address - Phone:405-789-4350
Practice Address - Fax:405-789-1662
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAT882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer