Provider Demographics
NPI:1356818116
Name:WINKELER, JAMES RAYMOND (PTA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RAYMOND
Last Name:WINKELER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-2012
Mailing Address - Country:US
Mailing Address - Phone:314-323-7818
Mailing Address - Fax:
Practice Address - Street 1:12335 W BEND DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2160
Practice Address - Country:US
Practice Address - Phone:877-931-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018026224225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant