Provider Demographics
NPI:1013573781
Name:WINTTERS, HEATHER KRISTEN (PTA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:KRISTEN
Last Name:WINTTERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 OLD GRANDE BLVD APT 315
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-4168
Mailing Address - Country:US
Mailing Address - Phone:903-530-2633
Mailing Address - Fax:
Practice Address - Street 1:921 SHILOH RD STE C120
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1407
Practice Address - Country:US
Practice Address - Phone:903-939-2800
Practice Address - Fax:866-386-4531
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2148731225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant