Healthcare Provider Details

I. General information

NPI: 1760365985
Provider Name (Legal Business Name): AIDAN JOEL WINTERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AIDAN JOEL DANIGELIS

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33135 SCHOOLCRAFT RD
LIVONIA MI
48150-1625
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TWP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 734-245-0930
  • Fax: 734-245-8830
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502008840
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: