Basic Information
| Provider Information | |||||||||
| NPI: | 1740545300 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WINTERHALTER | ||||||||
| FirstName: | LUCAS | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1952 ABERDEEN CT | ||||||||
| Address2: | |||||||||
| City: | SYCAMORE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601783175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157580000 | ||||||||
| FaxNumber: | 8157483014 | ||||||||
| Practice Location | |||||||||
| Address1: | 1310 N MAIN ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SANDWICH | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605481394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157866000 | ||||||||
| FaxNumber: | 8155702275 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2012 | ||||||||
| LastUpdateDate: | 02/11/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 12082-24 | WI | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 174400000X | 070020461 | IL | Y | Other Service Providers | Specialist |
No ID Information.