Provider Demographics
NPI:1194811604
Name:ONO, JERRY T (PT)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:T
Last Name:ONO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2353 AMOOMOO STREET
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782
Mailing Address - Country:US
Mailing Address - Phone:808-455-4074
Mailing Address - Fax:
Practice Address - Street 1:1314 SOUTH KING STREET
Practice Address - Street 2:SUITE 1451
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-593-2610
Practice Address - Fax:808-591-9420
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI23842-8OtherHMSA PPO/HMO/QUEST/65C
HI52694901Medicaid
HI52694900OtherALOHA CARE
HI210955OtherHMA
HI23842-8OtherTRICARE
HIH55027Medicare PIN