Provider Demographics
NPI:1508297722
Name:WINTERS, KYLE (AT, ATC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:WINTERS
Suffix:
Gender:M
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 S LAKESHORE DR
Mailing Address - Street 2:APT 182
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7164
Mailing Address - Country:US
Mailing Address - Phone:317-945-7653
Mailing Address - Fax:
Practice Address - Street 1:9332 N 95TH WAY STE 104
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5536
Practice Address - Country:US
Practice Address - Phone:317-945-7653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1147390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program