Provider Demographics
NPI:1629207956
Name:CAMACAYLAN, JONATHAN SORIANO (PT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:SORIANO
Last Name:CAMACAYLAN
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 1:68-1845 WAIKOLOA RD
Mailing Address - Street 2:STE 106 # 220
Mailing Address - City:WAIKOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96738
Mailing Address - Country:US
Mailing Address - Phone:808-883-3400
Mailing Address - Fax:808-883-3440
Practice Address - Street 1:68-1845 WAIKOLOA RD
Practice Address - Street 2:STE 211
Practice Address - City:WAIKOLOA
Practice Address - State:HI
Practice Address - Zip Code:96738
Practice Address - Country:US
Practice Address - Phone:808-883-3400
Practice Address - Fax:808-883-3440
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-2935225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist