Provider Demographics
NPI:1568790194
Name:WINSTON, CAROL (PT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:WINSTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 LASSEN LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-9002
Mailing Address - Country:US
Mailing Address - Phone:530-926-6010
Mailing Address - Fax:530-926-6909
Practice Address - Street 1:633 LASSEN LN
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-9002
Practice Address - Country:US
Practice Address - Phone:530-926-6010
Practice Address - Fax:530-926-6909
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060031208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation