Healthcare Provider Details

I. General information

NPI: 1144099045
Provider Name (Legal Business Name): KYLIE R NISHISAKA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 ALA MOANA BLVD STE 725
HONOLULU HI
96813-5417
US

IV. Provider business mailing address

677 ALA MOANA BLVD STE 725
HONOLULU HI
96813-5417
US

V. Phone/Fax

Practice location:
  • Phone: 808-734-0010
  • Fax: 808-734-0013
Mailing address:
  • Phone: 808-734-0010
  • Fax: 808-734-0013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-5838
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: