| Organization Name: | SOUTHSHORE PHYSICAL THERAPY & SPORTSMEDICINE |
| NPI Number: | 1760435218 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TIFFANY GRACE PRANGNELL (SOLE OWNER) |
| Mailing Address: | 380 Huku Lii Pl Kihei |
| State: | HI US |
| Postal Code: | 967537043 |
| Phone Number: | 8082984933 |
| Fax Number: | |
| NPI Enumeration Date: | 05/18/2006 |
| NPI Last Update Date: | 09/17/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 1830 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | HI |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |