Provider Demographics
NPI:1104509520
Name:WINSLOW, NOAH
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:WINSLOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 PIONEER PASS
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-8928
Mailing Address - Country:US
Mailing Address - Phone:419-202-7582
Mailing Address - Fax:
Practice Address - Street 1:2500 W STRUB RD STE 150
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5488
Practice Address - Country:US
Practice Address - Phone:419-626-4162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT020710208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation