Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2148731 | TX |
NPI | 1013573781 |
---|---|
Provider Name | Heather Kristen Wintters |
First Address | Tyler, TX 75703-4168 |
Second Address | Tyler, TX 75703-1407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2019 |
Last Update Date | 15/01/2020 |