Provider Demographics
NPI:1871865642
Name:WINTER, AMANDA JANE (PTA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANE
Last Name:WINTER
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 1:1130 COUNTY ROAD 1700 N
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-4207
Mailing Address - Country:US
Mailing Address - Phone:618-841-2473
Mailing Address - Fax:
Practice Address - Street 1:251 HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:NEW HARMONY
Practice Address - State:IN
Practice Address - Zip Code:47631-9075
Practice Address - Country:US
Practice Address - Phone:812-682-4104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003282A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant