Provider Demographics
NPI:1922236462
Name:GODWIN, AMY WINSTEAD (MPT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:WINSTEAD
Last Name:GODWIN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 WINTERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2714
Mailing Address - Country:US
Mailing Address - Phone:704-365-0895
Mailing Address - Fax:
Practice Address - Street 1:5114 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5852
Practice Address - Country:US
Practice Address - Phone:704-366-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist