Healthcare Provider Details

I. General information

NPI: 1528414067
Provider Name (Legal Business Name): MARIANNE WINTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E MOODY BLVD
BUNNELL FL
32110-5916
US

IV. Provider business mailing address

1400 E. MOODY BLVD.
BUNNELL FL
32110
US

V. Phone/Fax

Practice location:
  • Phone: 386-313-2599
  • Fax: 386-313-2577
Mailing address:
  • Phone: 386-313-2599
  • Fax: 386-313-2577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT17747
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: