Provider Demographics
NPI:1013391739
Name:LADWIG, ADAM (PT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:LADWIG
Suffix:
Gender:M
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:PO BOX 646
Mailing Address - Street 2:
Mailing Address - City:HAIKU
Mailing Address - State:HI
Mailing Address - Zip Code:96708-0646
Mailing Address - Country:US
Mailing Address - Phone:808-446-1872
Mailing Address - Fax:808-874-3040
Practice Address - Street 1:810 KOKOMO RD STE 148
Practice Address - Street 2:
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-5075
Practice Address - Country:US
Practice Address - Phone:808-446-1872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist