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NPI Code Detail

MEDICARE: BREANNA MARIE WINLING PTA

MEDICARE:   BREANNA MARIE WINLING  PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant5502005612MI

General Provider Information

NPI Number : 1487148219
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREANNA MARIE WINLING PTA
Provider Business Mailing Address
First Line : 2001 MINNEAPOLIS AVE STE C
Second Line :
City : GLADSTONE
State : MI
Zip : 49837-2060
Country : US
Telephone Number : 906-428-3085
Fax Number : 906-428-3086
Provider Business Practice Location Address
First Line : 2001 MINNEAPOLIS AVE STE C
Second Line :
City : GLADSTONE
State : MI
Zip : 49837-2060
Country : US
Telephone Number : 906-428-3085
Fax Number : 906-428-3086
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2018
Last Update Date : 06/15/2018

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Directions to “ BREANNA MARIE WINLING PTA” Practice Location

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