Provider Demographics
NPI:1164516589
Name:VAN DER HOUT, NANSIE R (PT)
Entity Type:Individual
Prefix:
First Name:NANSIE
Middle Name:R
Last Name:VAN DER HOUT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 KAKAHIAKA ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3460
Mailing Address - Country:US
Mailing Address - Phone:808-262-2818
Mailing Address - Fax:
Practice Address - Street 1:354 ULUNIU ST
Practice Address - Street 2:SUITE 404
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2528
Practice Address - Country:US
Practice Address - Phone:808-262-1118
Practice Address - Fax:808-262-0045
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI506371OtherHMA
HI53234203Medicaid
HI53234200OtherALOHA CARE
HI53234204Medicaid
HI53234203Medicaid