Healthcare Provider Details

I. General information

NPI: 1629972955
Provider Name (Legal Business Name): KYLIE ROSETTA DRAKE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-211 PALI MOMI ST STE 707
AIEA HI
96701-4339
US

IV. Provider business mailing address

91-925 NORTH RD APT A2
EWA BEACH HI
96706-2749
US

V. Phone/Fax

Practice location:
  • Phone: 808-450-9250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: