Provider Demographics
NPI:1689116477
Name:WINTERS, WILLIAM MICHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:WINTERS
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 1:5616 N CRIMSON WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-2839
Mailing Address - Country:US
Mailing Address - Phone:435-554-5219
Mailing Address - Fax:
Practice Address - Street 1:840 SW 4TH AVE
Practice Address - Street 2:STE 103
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2633
Practice Address - Country:US
Practice Address - Phone:541-881-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61925225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist