Provider Demographics
NPI:1942986005
Name:VONCARLOWITZ, WINSTON GRADY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:WINSTON
Middle Name:GRADY
Last Name:VONCARLOWITZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14126 PAINESVILLE WARREN RD
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9769
Mailing Address - Country:US
Mailing Address - Phone:216-965-1624
Mailing Address - Fax:
Practice Address - Street 1:2237 DEMING WAY
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-5510
Practice Address - Country:US
Practice Address - Phone:608-417-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16372-24225100000X
OHPT020404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist