NPIMap

Organization Active NPI

South Shore Physical Therapy & Sportsmedicine, Inc

  • Physical Therapist
  • Kahului, HI
National Provider Identifier
1396601647
Registry record updated Dec 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SOUTH SHORE PHYSICAL THERAPY & SPORTSMEDICINE, INC
Practice address
118 Maa St
Kahului, HI 96732-3602
Phone
(808) 244-0077
Fax
(808) 244-0177
NPI assigned
Dec 30, 2025
Last updated
Dec 30, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tiffany Grace PrangnellNPI 1881657633
Title
President
Phone
(808) 298-4933

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

118 Maa St
Kahului, HI 96732-3602

Mailing address

118 Maa St
Kahului, HI 96732-3602
Phone (808) 244-0077

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260206002714 HI DME Supplier - Independently-Practicing Physical Therapist 5799788808 Practice locations: Kahului, HI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Imua Physical Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

380 Huku Lii Pl
Ste 105
Kihei, HI 96753
Phone (808) 879-0077

3350 Lower Honoapiilani Rd
Ste 214
Lahaina, HI 96761
Phone (808) 667-2040

34 Kupuohi St
Ste 105
Lahaina, HI 96761
Phone (808) 879-0077

4310 Lower Honoapiilani Rd
Ste 110
Lahaina, HI 96761
Phone (808) 669-0078

40 Kupaoa St
#B201
Makawao, HI 96768
Phone (808) 298-4933

Practitioners & affiliated clinicians

Practitioners 35

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 35

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1767052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767052800000",
    "number": "1396601647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 MAA ST",
            "city": "KAHULUI",
            "state": "HI",
            "postal_code": "967323602",
            "telephone_number": "808-244-0077",
            "fax_number": "808-244-0177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 MAA ST",
            "city": "KAHULUI",
            "state": "HI",
            "postal_code": "967323602",
            "telephone_number": "808-244-0077",
            "fax_number": "808-244-0177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE PHYSICAL THERAPY & SPORTSMEDICINE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-12-30",
        "last_updated": "2025-12-30",
        "certification_date": "2025-12-30",
        "status": "A",
        "authorized_official_last_name": "PRANGNELL",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_middle_name": "GRACE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "808-298-4933"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kahului, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.