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Organization
CLEMSON SPORTS MEDICINE AND REHABILITATION INC
Active
Organization
CLEMSON SPORTS MEDICINE AND REHABILITATION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHARLEEN FITZGERALD (CREDENTIALING)
(864) 482-0064
Entity
Organization
Contact information
Practice address
10626 CLEMSON BLVD, SENECA, SC 29678-4526
(864) 482-0064
(864) 482-0074
Mailing address
PO BOX 1844, CLEMSON, SC 29633-1844
(864) 482-0064
(864) 482-0074
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
273Y00000X
Rehabilitation Hospital Unit
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5092260001
DMERC
SC
Enumeration date
07/01/2005
Last updated
11/17/2014
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