Basic Information
Provider Information
NPI: 1104267996
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WINKLER
FirstName: LAURA
MiddleName: BETH
NamePrefix: MS.
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5718
Address2:  
City: KALISPELL
State: MT
PostalCode: 599035718
CountryCode: US
TelephoneNumber: 4067560134
FaxNumber: 4063001612
Practice Location
Address1: 1231 N 27TH ST STE 1
Address2:  
City: BILLINGS
State: MT
PostalCode: 591010106
CountryCode: US
TelephoneNumber: 4069692518
FaxNumber: 4069692520
Other Information
ProviderEnumerationDate: 07/10/2013
LastUpdateDate: 07/16/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/16/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPTP-PT-LIC-5958MTY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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