Healthcare Provider Details

I. General information

NPI: 1295704336
Provider Name (Legal Business Name): MICHAEL VINCENT WINTERS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP FORT BELVOIR COMMUNITY HOSPITAL
FORT BELVOIR VA
22060
US

IV. Provider business mailing address

9300 DEWITT LOOP
FORT BELVOIR VA
22060-5285
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-2460
  • Fax:
Mailing address:
  • Phone: 571-231-2198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number1163120
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number2305205009
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305205009
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: