Provider Demographics
NPI:1033810429
Name:WINTERS, CAROLINE BLIGHT (PTA)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:BLIGHT
Last Name:WINTERS
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 1:1137 E 140 N
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-2528
Mailing Address - Country:US
Mailing Address - Phone:801-803-1239
Mailing Address - Fax:
Practice Address - Street 1:524 W 300 N STE 201
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-2669
Practice Address - Country:US
Practice Address - Phone:801-658-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10196151-2402225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant