Provider Demographics
NPI:1578232542
Name:KIKUGAWA, KAILA (DPT)
Entity Type:Individual
Prefix:
First Name:KAILA
Middle Name:
Last Name:KIKUGAWA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 MONUMENT VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-1518
Mailing Address - Country:US
Mailing Address - Phone:808-753-8004
Mailing Address - Fax:
Practice Address - Street 1:214 W 27TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4306
Practice Address - Country:US
Practice Address - Phone:308-633-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-12
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist