Provider Demographics
NPI:1619556552
Name:GROUNDSWELL PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:GROUNDSWELL PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LADWIG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:808-446-1872
Mailing Address - Street 1:810 KOKOMO RD STE 148
Mailing Address - Street 2:
Mailing Address - City:HAIKU
Mailing Address - State:HI
Mailing Address - Zip Code:96708-5075
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy