Provider Demographics
NPI:1265615074
Name:WINN, PETER A (PT)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:A
Last Name:WINN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 HOLLY CT SW
Mailing Address - Street 2:
Mailing Address - City:CALABASH
Mailing Address - State:NC
Mailing Address - Zip Code:28467-2419
Mailing Address - Country:US
Mailing Address - Phone:910-579-4631
Mailing Address - Fax:
Practice Address - Street 1:1733 SEASIDE ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:SUNSET BEACH
Practice Address - State:NC
Practice Address - Zip Code:28468
Practice Address - Country:US
Practice Address - Phone:910-575-2775
Practice Address - Fax:910-575-2776
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11336225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist