Healthcare Provider Details

I. General information

NPI: 1477860732
Provider Name (Legal Business Name): HEIDI WINSTEAD DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 WOLVERINE TRL STE 201
SMYRNA TN
37167-5656
US

IV. Provider business mailing address

511 RIVER FORD DR
MARYVILLE TN
37804-6301
US

V. Phone/Fax

Practice location:
  • Phone: 615-220-5796
  • Fax:
Mailing address:
  • Phone: 615-491-5972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0000008228
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT0000008228
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: