Basic Information
| Provider Information | |||||||||
| NPI: | 1356438907 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WINTERSTEIN | ||||||||
| FirstName: | ANGIE | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WINTERSTEIN | ||||||||
| OtherFirstName: | ANNEGELA | ||||||||
| OtherMiddleName: | LYNN | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10 TARNSIDE CT | ||||||||
| Address2: | |||||||||
| City: | BLYTHEWOOD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290169090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037140010 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2705 LEAPHART RD | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291693335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039265119 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 01/24/2008 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 995 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.