Healthcare Provider Details

I. General information

NPI: 1720698095
Provider Name (Legal Business Name): AMBER NICOLE WINCEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2987 PLAZA DR
DUNKIRK MD
20754-2735
US

IV. Provider business mailing address

350 NEW FIDELITY CT
GARNER NC
27529-2665
US

V. Phone/Fax

Practice location:
  • Phone: 443-964-6348
  • Fax:
Mailing address:
  • Phone: 919-258-2714
  • Fax: 410-648-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28013
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: