Provider Demographics
NPI:1710397658
Name:WINTHROP PT, PS
Entity Type:Organization
Organization Name:WINTHROP PT, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOKES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:509-996-8234
Mailing Address - Street 1:PO BOX 814
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:WA
Mailing Address - Zip Code:98862-0814
Mailing Address - Country:US
Mailing Address - Phone:509-996-8234
Mailing Address - Fax:509-996-2193
Practice Address - Street 1:202 WHITE AVE
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:WA
Practice Address - Zip Code:98862-9774
Practice Address - Country:US
Practice Address - Phone:509-996-8234
Practice Address - Fax:509-996-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60290704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty