Provider Demographics
NPI:1548034739
Name:NADOLNY, EDWARD JOHN (PTA)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOHN
Last Name:NADOLNY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 OPIHIKAO WAY
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-1123
Mailing Address - Country:US
Mailing Address - Phone:508-561-0050
Mailing Address - Fax:
Practice Address - Street 1:850 W HIND DR STE 201
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1845
Practice Address - Country:US
Practice Address - Phone:808-377-5605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8936225200000X
HIPTA-631225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant