Provider Demographics
NPI:1023256633
Name:WINNIE, THERESA AUDREY (PTA)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:AUDREY
Last Name:WINNIE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:AUDREY
Other - Last Name:WINNIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:8477 S SUNCOAST BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-5028
Mailing Address - Country:US
Mailing Address - Phone:800-381-0822
Mailing Address - Fax:525-655-2013
Practice Address - Street 1:8477 S SUNCOAST BLVD
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446-5028
Practice Address - Country:US
Practice Address - Phone:800-381-0822
Practice Address - Fax:525-655-2013
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21570225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106898OtherMEDICARE ID