# JACO VAN DELDEN PHYSICAL REHABILITATION LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063746196
- **Authorized official:** MR. JACO J VAN DELDEN P.T. (OWNER)
- **Authorized official phone:** (808) 381-8947

## Contact information

- **Practice address:** 1401 S BERETANIA ST STE 550, HONOLULU, HI 96814-1880
- **Practice address phone:** (808) 381-8947
- **Practice address fax:** (808) 591-2245
- **Mailing address:** 1401 S BERETANIA ST STE 550, HONOLULU, HI 96814-1880
- **Mailing address phone:** (808) 381-8947
- **Mailing address fax:** (808) 591-2245

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | PT-1582 | HI | Yes |

## Other

- **Enumeration date:** 09/22/2009
- **Last updated:** 11/07/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | A20852-8 | HMSA | HI |