| Organization Name: | SOUTH SHORE PT & SPORTSMEDICINE, INC. |
| NPI Number: | 1114354198 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TIFFANY GRACE PRANGNELL (OWNER) |
| Mailing Address: | 40 Kupuohi St Suite 105 Lahaina |
| State: | HI US |
| Postal Code: | 967612741 |
| Phone Number: | 8088790077 |
| Fax Number: | 8088790177 |
| NPI Enumeration Date: | 10/04/2013 |
| NPI Last Update Date: | 05/12/2014 |
| 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: | |