Provider Demographics
NPI:1720708274
Name:WINN, CHAD TYLER (DPT)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:TYLER
Last Name:WINN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 LOVELL WAY
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CA
Mailing Address - Zip Code:93523-2626
Mailing Address - Country:US
Mailing Address - Phone:603-812-8597
Mailing Address - Fax:
Practice Address - Street 1:30 NIGHTINGALE ROAD
Practice Address - Street 2:
Practice Address - City:EDWARDS AFB
Practice Address - State:CA
Practice Address - Zip Code:93524-4423
Practice Address - Country:US
Practice Address - Phone:661-277-3891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5051225100000X
MD29183225100000X
MEPT6648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist