Provider Demographics
NPI:1184294373
Name:DR NICK BRONOWSKI PT LLC
Entity type:Organization
Organization Name:DR NICK BRONOWSKI PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRONOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:808-546-0937
Mailing Address - Street 1:2916 DATE ST APT 20B
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-1189
Mailing Address - Country:US
Mailing Address - Phone:808-546-0937
Mailing Address - Fax:
Practice Address - Street 1:2916 DATE ST APT 20B
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-1189
Practice Address - Country:US
Practice Address - Phone:808-546-0937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy