Provider Demographics
NPI:1255367249
Name:WINTER, THERESA GAYLE (RRT)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:GAYLE
Last Name:WINTER
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-3045
Mailing Address - Country:US
Mailing Address - Phone:620-804-6104
Mailing Address - Fax:620-285-6012
Practice Address - Street 1:117 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-3045
Practice Address - Country:US
Practice Address - Phone:620-804-6104
Practice Address - Fax:620-285-6012
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS16-002782251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100444200BMedicaid
KS0000048194OtherBLUE CROSS/BLUE SHIELD NO
KS0227760001Medicare NSC