Active NPI
Wilbur Van Winkle III, LMT
- Massage Therapist
- Lebanon, TN
National Provider Identifier
1356701601
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 10962
- Practice address
- 1704 Summerfield Dr Apt 1
Lebanon, TN 37087-4811 - Phone
- (615) 423-1442
- NPI assigned
- Feb 29, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 10962 | TN | Primary |
| Massage Therapist | 225700000X | 113838 | TX |
Addresses
Primary practice location
1704 Summerfield Dr Apt 1
Lebanon, TN 37087-4811
Mailing address
1704 Summerfield Dr Apt 1
Lebanon, TN 37087-4811
Phone (615) 423-1442
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 113838 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1456704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456704000000",
"number": "1356701601",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1704 SUMMERFIELD DR APT 1",
"city": "LEBANON",
"state": "TN",
"postal_code": "370874811",
"telephone_number": "615-423-1442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1704 SUMMERFIELD DR APT 1",
"city": "LEBANON",
"state": "TN",
"postal_code": "370874811",
"telephone_number": "615-423-1442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN WINKLE",
"first_name": "WILBUR",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-02-29",
"last_updated": "2016-02-29",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "TN",
"license": "10962",
"primary": true
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "TX",
"license": "113838",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.