Provider Demographics
NPI:1427202548
Name:WINCHELL, TIMOTHY D (DPT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:WINCHELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 ARQUINT RD
Mailing Address - Street 2:
Mailing Address - City:VERNON CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13477-3506
Mailing Address - Country:US
Mailing Address - Phone:315-829-3532
Mailing Address - Fax:
Practice Address - Street 1:3721 ARQUINT RD
Practice Address - Street 2:
Practice Address - City:VERNON CENTER
Practice Address - State:NY
Practice Address - Zip Code:13477-3506
Practice Address - Country:US
Practice Address - Phone:315-829-3532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017731-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics