Provider Demographics
NPI:1801846332
Name:WINEBRENNER, MICHAEL THOMAS (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:THOMAS
Last Name:WINEBRENNER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 E ROLLING XRDS
Mailing Address - Street 2:STE 57
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6212
Mailing Address - Country:US
Mailing Address - Phone:443-860-9168
Mailing Address - Fax:443-636-5987
Practice Address - Street 1:20 CROSSROADS DR STE 13
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5479
Practice Address - Country:US
Practice Address - Phone:410-363-0015
Practice Address - Fax:410-356-7763
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF962Medicare UPIN
MDP33525Medicare UPIN
MD256152Y5FMedicare PIN