Provider Demographics
NPI:1932575008
Name:WINTER, AUDRA (PT)
Entity type:Individual
Prefix:MISS
First Name:AUDRA
Middle Name:
Last Name:WINTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 DRIVE 1345
Mailing Address - Street 2:
Mailing Address - City:MOOREVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38857-7128
Mailing Address - Country:US
Mailing Address - Phone:662-322-2312
Mailing Address - Fax:
Practice Address - Street 1:123 DRIVE 1345
Practice Address - Street 2:
Practice Address - City:MOOREVILLE
Practice Address - State:MS
Practice Address - Zip Code:38857-7128
Practice Address - Country:US
Practice Address - Phone:662-322-2312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT2711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist