Provider Demographics
NPI:1295800431
Name:RADWAN, HAMDY A (PT, PHD)
Entity type:Individual
Prefix:
First Name:HAMDY
Middle Name:A
Last Name:RADWAN
Suffix:
Gender:M
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 SCHOOL CREEK PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-4013
Mailing Address - Country:US
Mailing Address - Phone:919-244-1143
Mailing Address - Fax:
Practice Address - Street 1:3214 CHARLES B ROOT WYND
Practice Address - Street 2:SUITE #155
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5440
Practice Address - Country:US
Practice Address - Phone:919-781-7740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211499Medicaid
NCP00116234OtherRAILROAD MEDICARE
079E1OtherBCBS
NC2505093Medicare PIN