Provider Demographics
NPI:1659306678
Name:WINDERS, KRISTOPHER WAYNE
Entity Type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:WAYNE
Last Name:WINDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 OLD TODDS RD
Mailing Address - Street 2:#260
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:162 OLD TODDS RD
Practice Address - Street 2:#260
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1336
Practice Address - Country:US
Practice Address - Phone:859-654-0119
Practice Address - Fax:859-652-3903
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6708225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ339918422Medicare ID - Type Unspecified