Provider Demographics
NPI:1578885901
Name:WINTERS, JACKLYN M (DPT)
Entity Type:Individual
Prefix:DR
First Name:JACKLYN
Middle Name:M
Last Name:WINTERS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12640 S ROUTE 59
Mailing Address - Street 2:UNIT 110
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5400
Mailing Address - Country:US
Mailing Address - Phone:815-676-3905
Mailing Address - Fax:630-754-8390
Practice Address - Street 1:1337 LILY CACHE LN
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-4600
Practice Address - Country:US
Practice Address - Phone:630-226-5110
Practice Address - Fax:630-226-5120
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017657225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic