Provider Demographics
NPI:1689732893
Name:WINTZ, YOLANDA (MS,PT)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:WINTZ
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,PT
Mailing Address - Street 1:418 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-1608
Mailing Address - Country:US
Mailing Address - Phone:267-304-2422
Mailing Address - Fax:
Practice Address - Street 1:1829 E FRANKLIN ST STE 600
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5863
Practice Address - Country:US
Practice Address - Phone:919-968-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC92172251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211769Medicaid