Provider Demographics
NPI:1720447055
Name:WINTRINGHAM, DAVID JR (MED, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WINTRINGHAM
Suffix:JR
Gender:M
Credentials:MED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10706 WATERFORD CREEK LN
Mailing Address - Street 2:APT 302
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-7269
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10706 WATERFORD CREEK LN
Practice Address - Street 2:APT 302
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-7269
Practice Address - Country:US
Practice Address - Phone:336-266-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-23382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer