Provider Demographics
NPI:1376717686
Name:WINTERS, SUSAN M (PTA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
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:PO BOX 60081
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-0081
Mailing Address - Country:US
Mailing Address - Phone:508-853-4590
Mailing Address - Fax:508-459-5900
Practice Address - Street 1:50 BOSTON TPKE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3540
Practice Address - Country:US
Practice Address - Phone:508-753-7780
Practice Address - Fax:508-753-7719
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.004884225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant