Provider Demographics
NPI:1891820247
Name:VALANT, JESSICA STARE (MSPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:STARE
Last Name:VALANT
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 KAILUA RD
Mailing Address - Street 2:#202
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2841
Mailing Address - Country:US
Mailing Address - Phone:808-277-7641
Mailing Address - Fax:
Practice Address - Street 1:602 KAILUA RD
Practice Address - Street 2:#202
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2841
Practice Address - Country:US
Practice Address - Phone:808-277-7641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI59164501Medicaid
HI0000267864OtherHMSA