Provider Demographics
NPI:1891931846
Name:WINCHELL, KASEY (PT)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:WINCHELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18688 AUTUMN LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6473
Mailing Address - Country:US
Mailing Address - Phone:518-369-9162
Mailing Address - Fax:
Practice Address - Street 1:18688 AUTUMN LAKE BLVD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6473
Practice Address - Country:US
Practice Address - Phone:518-369-9162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32917225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI001475401Medicare PIN