Provider Demographics
NPI:1669518817
Name:WINK, PAIGE B (PT)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:B
Last Name:WINK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 TURKEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:HADDAM
Mailing Address - State:CT
Mailing Address - Zip Code:06438-1204
Mailing Address - Country:US
Mailing Address - Phone:860-345-3649
Mailing Address - Fax:
Practice Address - Street 1:23 KILLINGWORTH RD
Practice Address - Street 2:
Practice Address - City:HIGGANUM
Practice Address - State:CT
Practice Address - Zip Code:06441-4242
Practice Address - Country:US
Practice Address - Phone:860-345-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080005371CT04OtherANTHEM BLUE CROSS/BLUE SHIELD OF CT
CTP3818445OtherOXFORD
CT1479552OtherAETNA