Provider Demographics
NPI:1710959838
Name:DOLEGOWSKI, EDWARD MICHAEL (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:MICHAEL
Last Name:DOLEGOWSKI
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:10785 W TWAIN AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-3026
Mailing Address - Country:US
Mailing Address - Phone:725-726-7847
Mailing Address - Fax:
Practice Address - Street 1:9310 SUN CITY BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-1705
Practice Address - Country:US
Practice Address - Phone:725-726-7847
Practice Address - Fax:725-726-7876
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1710959838Medicaid
37394Medicare ID - Type Unspecified