Provider Demographics
NPI:1821304437
Name:WIMP, JAMES LEONARD (CPTA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LEONARD
Last Name:WIMP
Suffix:
Gender:M
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6052 X-RAY RD.
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:KS
Mailing Address - Zip Code:67356
Mailing Address - Country:US
Mailing Address - Phone:620-717-3964
Mailing Address - Fax:
Practice Address - Street 1:1217 S 15TH ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-5125
Practice Address - Country:US
Practice Address - Phone:620-421-2431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01905225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant