Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 033308-1 | NY |
N | 2251G0304X | Physical Therapist - Geriatrics | 033308-1 | NY |
N | 2251N0400X | Physical Therapist - Neurology | 033308-1 | NY |
N | 2251P0200X | Physical Therapist - Pediatrics | 033308-1 | NY |
Y | 2251X0800X | Physical Therapist - Orthopedic | 033308-1 | NY |
NPI | 1497004766 |
---|---|
Provider Name | Jannis B Winstead |
First Address | White Plains, NY 10601-4803 |
Second Address | Bronx, NY 10460-4301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2012 |
Last Update Date | 13/04/2016 |