Jared Van Winkle, PT, DPT
Individual provider Active NPI Physical Therapist · Wagner, SD
NPI 1457950321 · NPPES record last updated Oct 21, 2020
Key facts
- NPI
- 1457950321
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 2117 (SD)
- Practice address
- 513 3Rd St SW
Wagner, SD 57380-9675 - Phone
- (605) 384-3611
- NPI assigned
- Oct 21, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2117 | SD | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2117 | SD | Yes |
Addresses
Primary practice location
513 3Rd St SW
Wagner, SD 57380-9675
Mailing address
302 E 14TH Ave
Tyndall, SD 57066-2254
Phone (605) 857-0043
Other providers in Wagner, SD
- The Evangelical Lutheran Good Samaritan Society
- The Evangelical Lutheran Good Samaritan Society
- Jodi Jean Thompson
- TK Dispensing
- Edgardo Toro Velez
- Jessica M Vanderham
- Vanessa Iverson, LLC
- Diana Lynn Wackel
- Wagner Community Memorial Hospital
- Wagner Community Memorial Hospital
All providers in Wagner, SD · Physical Therapist in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 21, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.