Provider Demographics
NPI:1023794740
Name:WINCHESTER, IAN LEE PURISIMA (DPT)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:LEE PURISIMA
Last Name:WINCHESTER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-9038
Mailing Address - Country:US
Mailing Address - Phone:573-855-0481
Mailing Address - Fax:
Practice Address - Street 1:7279 W 105TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-2515
Practice Address - Country:US
Practice Address - Phone:913-642-7746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist