Provider Demographics
NPI:1114223021
Name:WINSTEAD, CHARLES MITCHELL (PTA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:MITCHELL
Last Name:WINSTEAD
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7325 RABBIT HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-7411
Mailing Address - Country:US
Mailing Address - Phone:910-452-1922
Mailing Address - Fax:910-313-1698
Practice Address - Street 1:7325 RABBIT HOLLOW DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-7411
Practice Address - Country:US
Practice Address - Phone:910-452-1922
Practice Address - Fax:910-313-1698
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1459225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant