Provider Demographics
NPI:1619023181
Name:SOUTH SHORE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:SOUTH SHORE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-596-2333
Mailing Address - Street 1:1221 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 730
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3503
Mailing Address - Country:US
Mailing Address - Phone:808-596-2333
Mailing Address - Fax:808-596-4545
Practice Address - Street 1:1221 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 730
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3503
Practice Address - Country:US
Practice Address - Phone:808-596-2333
Practice Address - Fax:808-596-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI611578900OtherOWCP
HIZ1683OtherMDX
HI0000256479OtherHMSA(BCBS) PIN
HI=========OtherALL WORK COMP
HI=========OtherHMAA
HIZ1683OtherMDX