Provider Demographics
NPI:1760432892
Name:DOLEZAL, HEIDI (MPT)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:DOLEZAL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4-901 KUHIO HWY STE A
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-1549
Mailing Address - Country:US
Mailing Address - Phone:808-826-6000
Mailing Address - Fax:844-965-9830
Practice Address - Street 1:4-901 KUHIO HWY STE A
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1549
Practice Address - Country:US
Practice Address - Phone:808-826-6000
Practice Address - Fax:844-965-9830
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4897225100000X
TX1113272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist