| Organization Name: | SOUTH SHORE PHYSICAL THERAPY & SPORTSMEDICINE, INC |
| NPI Number: | 1053617829 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TIFFANY G PRANGNELL (OWNER, PRESIDENT) |
| Mailing Address: | 380 Huku Lii Pl Ste 105 Kihei |
| State: | HI US |
| Postal Code: | 967537043 |
| Phone Number: | 8088790077 |
| Fax Number: | 8088790177 |
| NPI Enumeration Date: | 01/26/2011 |
| NPI Last Update Date: | 09/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 1830 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | HI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |