Provider Demographics
NPI:1548213689
Name:ANGARAN, JEREMY (DPT)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:ANGARAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 161172
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-0925
Mailing Address - Country:US
Mailing Address - Phone:808-294-5058
Mailing Address - Fax:
Practice Address - Street 1:1618 IWI WAY
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3822
Practice Address - Country:US
Practice Address - Phone:808-294-5058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008894225100000X
HI2919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7250ANOtherREGENCE
WA0162289OtherLABOR & INDUSTRIES
WA8346744Medicaid
WAL&I CRIME VICTIM PRGOther8930572
WA7250ANOtherREGENCE
WA8346744Medicaid