Provider Demographics
NPI:1790880888
Name:KPT CORPORATION
Entity Type:Organization
Organization Name:KPT CORPORATION
Other - Org Name:KULA PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NEWSOM
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:808-875-6690
Mailing Address - Street 1:1819 S KIHEI RD STE D104
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7940
Mailing Address - Country:US
Mailing Address - Phone:808-875-6690
Mailing Address - Fax:808-875-6691
Practice Address - Street 1:100 KEOKEA PL
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-7450
Practice Address - Country:US
Practice Address - Phone:808-264-2135
Practice Address - Fax:866-646-1468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI100032Medicare UPIN
HIH53684Medicare PIN