Healthcare Provider Details

I. General information

NPI: 1669518817
Provider Name (Legal Business Name): PAIGE B. WINK P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 KILLINGWORTH RD
HIGGANUM CT
06441-4242
US

IV. Provider business mailing address

233 TURKEY HILL RD
HADDAM CT
06438-1204
US

V. Phone/Fax

Practice location:
  • Phone: 860-345-2622
  • Fax:
Mailing address:
  • Phone: 860-345-3649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number005371
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: