# COUNTRYSIDE PHYSICAL THERAPY, INC.

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

## Provider details

- **NPI number:** 1124187786
- **Authorized official:** KYLE KIKUCHI DPT (CEO)
- **Authorized official phone:** (808) 637-4010

## Contact information

- **Practice address:** 67-292 GOODALE AVE \#A4, WAIALUA, HI 96791
- **Practice address phone:** (808) 637-4010
- **Practice address fax:** (808) 637-6020
- **Mailing address:** 67-188 KUHI ST, WAIALUA, HI 96791-9634

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | PT-2333 | HI | Yes |

## Other

- **Enumeration date:** 12/08/2006
- **Last updated:** 01/22/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2058706 | UNIVERSITY HEALTH ALLIANC | HI |
| 01 | — | 258921 | HMSA | HI |
| 01 | — | 540856 | HMA, INC. HAWAII | HI |
| 05 | — | 578461 | — | HI |
| 01 | — | 57847900 | ALOHACARE | HI |