Basic Information
| Provider Information | |||||||||
| NPI: | 1194811604 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ONO | ||||||||
| FirstName: | JERRY | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2353 AMOOMOO STREET | ||||||||
| Address2: | |||||||||
| City: | PEARL CITY | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084554074 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1314 SOUTH KING STREET | ||||||||
| Address2: | SUITE 1451 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085932610 | ||||||||
| FaxNumber: | 8085919420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT559 | HI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 23842-8 | 01 | HI | HMSA PPO/HMO/QUEST/65C | OTHER | 52694901 | 05 | HI | MEDICAID | 52694900 | 01 | HI | ALOHA CARE | OTHER | 210955 | 01 | HI | HMA | OTHER | 23842-8 | 01 | HI | TRICARE | OTHER |