Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1962413195 |
---|---|
Provider Name | Mr. Michael Shayne Winters |
First Address | Prescott, AZ 86303-5795 |
Second Address | Prescott, AZ 86313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/07/2007 |