Provider Demographics
NPI:1518582311
Name:WINNESTAFFER, AMBER NICOLE (PTA 07025)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:WINNESTAFFER
Suffix:
Gender:F
Credentials:PTA 07025
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14176 NATIONAL RD SW
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:OH
Mailing Address - Zip Code:43068-3363
Mailing Address - Country:US
Mailing Address - Phone:740-927-6782
Mailing Address - Fax:
Practice Address - Street 1:14176 NATIONAL RD SW
Practice Address - Street 2:
Practice Address - City:ETNA
Practice Address - State:OH
Practice Address - Zip Code:43068-3363
Practice Address - Country:US
Practice Address - Phone:740-927-6782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07025208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation