Provider Demographics
NPI:1801408232
Name:WINKLE, JIMMY LEE (LMT)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:LEE
Last Name:WINKLE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1205 S ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-5329
Mailing Address - Country:US
Mailing Address - Phone:918-845-8191
Mailing Address - Fax:
Practice Address - Street 1:4564 S HARVARD AVE STE B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2918
Practice Address - Country:US
Practice Address - Phone:918-508-2220
Practice Address - Fax:918-508-2221
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK103368225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist