Provider Demographics
NPI:1033347364
Name:HOLTON, WINSTON (LMT)
Entity Type:Individual
Prefix:MR
First Name:WINSTON
Middle Name:
Last Name:HOLTON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 E HIGHWAY 50
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5186
Mailing Address - Country:US
Mailing Address - Phone:352-394-7577
Mailing Address - Fax:352-394-8000
Practice Address - Street 1:1705 E HIGHWAY 50
Practice Address - Street 2:SUITE B
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5186
Practice Address - Country:US
Practice Address - Phone:352-394-7577
Practice Address - Fax:352-394-8000
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0018677225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist