Healthcare Provider Details

I. General information

NPI: 1013231174
Provider Name (Legal Business Name): MARIE NELSON WINTERSCHEID P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 DIXON RECREATION CTR
CORVALLIS OR
97331-8501
US

IV. Provider business mailing address

1140 EDGEWATER DR
WALDPORT OR
97394-9058
US

V. Phone/Fax

Practice location:
  • Phone: 541-737-7556
  • Fax: 541-737-7721
Mailing address:
  • Phone: 541-264-0024
  • Fax: 541-737-7721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number3524
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: