Provider Demographics
NPI:1093853624
Name:VAN DELDEN, JACO J (PT)
Entity Type:Individual
Prefix:
First Name:JACO
Middle Name:J
Last Name:VAN DELDEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944A 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-2910
Mailing Address - Country:US
Mailing Address - Phone:808-381-8947
Mailing Address - Fax:
Practice Address - Street 1:932 WARD AVE
Practice Address - Street 2:7TH FLOOR
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2131
Practice Address - Country:US
Practice Address - Phone:808-381-8947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-1582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA20852-8OtherHMSA
HIH51876Medicare PIN