Organization
COUNTRYSIDE PHYSICAL THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE KIKUCHI DPT (CEO)
(808) 637-4010
Entity
Organization
Contact information
Practice address
67-292 GOODALE AVE #A4, WAIALUA, HI 96791
(808) 637-4010
(808) 637-6020
Mailing address
67-188 KUHI ST, WAIALUA, HI 96791-9634
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-2333
HI
Other
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
Enumeration date
12/08/2006
Last updated
01/22/2009
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