Healthcare Provider Details

I. General information

NPI: 1033347364
Provider Name (Legal Business Name): WINSTON HOLTON LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 E HIGHWAY 50 SUITE B
CLERMONT FL
34711-5186
US

IV. Provider business mailing address

1705 E HIGHWAY 50 SUITE B
CLERMONT FL
34711-5186
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-7577
  • Fax: 352-394-8000
Mailing address:
  • Phone: 352-394-7577
  • Fax: 352-394-8000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA0018677
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: