Healthcare Provider Details

I. General information

NPI: 1649146788
Provider Name (Legal Business Name): CHRISTINE WYLDE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 RAILROAD AVE # A4
HILO HI
96720-7509
US

IV. Provider business mailing address

28 SPRING ST
HILO HI
96720-2047
US

V. Phone/Fax

Practice location:
  • Phone: 808-339-7989
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-5840
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: