Provider Demographics
NPI:1154861326
Name:WINTTER, DRU (LMT)
Entity Type:Individual
Prefix:MS
First Name:DRU
Middle Name:
Last Name:WINTTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 E CAMELLIA DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-3927
Mailing Address - Country:US
Mailing Address - Phone:985-209-4157
Mailing Address - Fax:
Practice Address - Street 1:1302 E CAMELLIA DR
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-3927
Practice Address - Country:US
Practice Address - Phone:985-209-4157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3254225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist