# SOUTH SHORE PHYSICAL THERAPY & SPORTSMEDICINE, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396601647
- **Authorized official:** TIFFANY GRACE PRANGNELL (PRESIDENT)
- **Authorized official phone:** (808) 298-4933

## Contact information

- **Practice address:** 118 MAA ST, KAHULUI, HI 96732-3602
- **Practice address phone:** (808) 244-0077
- **Practice address fax:** (808) 244-0177
- **Mailing address:** 118 MAA ST, KAHULUI, HI 96732-3602
- **Mailing address phone:** (808) 244-0077
- **Mailing address fax:** (808) 244-0177

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 12/30/2025
- **Last updated:** 12/30/2025