Provider Demographics
NPI:1316251952
Name:WINTER, LONNIE RAY (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:LONNIE
Middle Name:RAY
Last Name:WINTER
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4342 GALLA STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW BOSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45662
Mailing Address - Country:US
Mailing Address - Phone:740-456-8888
Mailing Address - Fax:740-456-8889
Practice Address - Street 1:4342 GALLA STREET
Practice Address - Street 2:SUITE B
Practice Address - City:NEW BOSTON
Practice Address - State:OH
Practice Address - Zip Code:45662
Practice Address - Country:US
Practice Address - Phone:740-456-8888
Practice Address - Fax:740-456-8889
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.019065T-2225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist