Countryside Physical Therapy, Inc.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-2333 Issued in HI

Legal business name

COUNTRYSIDE PHYSICAL THERAPY, INC.

Practice address

67-292 Goodale Ave #A4
Waialua, HI 96791

Phone

(808) 637-4010

Fax

(808) 637-6020

NPI assigned

Dec 8, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kyle Kikuchi, DPT

Title

Ceo

Phone

(808) 637-4010

Specialties & licenses 1

Addresses

Other identifiers 5

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232582400000",
    "number": "1124187786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67-188 KUHI ST",
            "city": "WAIALUA",
            "state": "HI",
            "postal_code": "967919634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67-292 GOODALE AVE #A4",
            "city": "WAIALUA",
            "state": "HI",
            "postal_code": "96791",
            "telephone_number": "808-637-4010",
            "fax_number": "808-637-6020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYSIDE PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2009-01-22",
        "status": "A",
        "authorized_official_last_name": "KIKUCHI",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "808-637-4010",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "HI",
            "license": "PT-2333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMSA",
            "identifier": "258921",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERSITY HEALTH ALLIANC",
            "identifier": "2058706",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMA, INC. HAWAII",
            "identifier": "540856",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "578461",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALOHACARE",
            "identifier": "57847900",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexis Helen Cannon, NBC-HWC
• Carrie Cochran, MFT LLC
• Laura Cho-Stutler, PSY.D.
• Lani Chow
• Caroline Cochran, MFT
• Zahava N Czara
• Nancy K L Delamarter, LCSW
• Kali Jane Dowis
• Alexis Anastasia Mize Einolghozati
• Kurtus Michael Esser, DC

• Physical Therapist in Waialua, HI
• Providers in Waialua, HI by specialty
• Physical Therapist in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.