Provider Demographics
NPI:1982781746
Name:WINTER, JILL R (PT)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:R
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 1:3009 MASON CT
Mailing Address - Street 2:
Mailing Address - City:LAKE WYLIE
Mailing Address - State:SC
Mailing Address - Zip Code:29710-8106
Mailing Address - Country:US
Mailing Address - Phone:803-631-5485
Mailing Address - Fax:803-631-5483
Practice Address - Street 1:3009 MASON CT
Practice Address - Street 2:
Practice Address - City:LAKE WYLIE
Practice Address - State:SC
Practice Address - Zip Code:29710-8106
Practice Address - Country:US
Practice Address - Phone:803-631-5485
Practice Address - Fax:803-631-5483
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1740Medicaid