Provider Demographics
NPI:1336669878
Name:WINDING, DETRICK LASHAE (PTA)
Entity Type:Individual
Prefix:
First Name:DETRICK
Middle Name:LASHAE
Last Name:WINDING
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 1:110 SERIO BLVD.
Mailing Address - Street 2:THERAPY DEPT.
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334
Mailing Address - Country:US
Mailing Address - Phone:318-757-4031
Mailing Address - Fax:
Practice Address - Street 1:110 SERIO BLVD.
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334
Practice Address - Country:US
Practice Address - Phone:318-757-4030
Practice Address - Fax:318-757-4031
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA09703225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant