| Organization Name: | SOUTHSHORE PHYSICAL THERAPY & SPORTSMEDICINE |
| NPI Number: | 1235560657 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TIFFANY G PRANGNELL (OWNER/PRESIDENT) |
| Mailing Address: | 3350 Lower Honoapiilani Rd Ste 214 Lahaina |
| State: | HI US |
| Postal Code: | 967618404 |
| Phone Number: | 8086690078 |
| Fax Number: | 8086690178 |
| NPI Enumeration Date: | 12/11/2013 |
| NPI Last Update Date: | 05/09/2014 |
| 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: | |