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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