Provider Demographics
NPI:1487124079
Name:WINTERS, DALE ERNEST (PTA)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:ERNEST
Last Name:WINTERS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 N. 8TH ST.
Mailing Address - Street 2:
Mailing Address - City:MT. HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572
Mailing Address - Country:US
Mailing Address - Phone:608-437-5511
Mailing Address - Fax:608-437-9604
Practice Address - Street 1:407 N. 8TH ST.
Practice Address - Street 2:
Practice Address - City:MT. HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572
Practice Address - Country:US
Practice Address - Phone:608-437-5511
Practice Address - Fax:608-437-9604
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2861-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant