Organization
CLEMSON SPORTS MEDICINE AND REHABILITATION
Active
Parent organization
CLEMSON SPORTS MEDICINE AND REHABILITATION
Other names
Myrtle Beach Physical Therapy
Organization subpart
Yes
Provider details
NPI number
Legal business name
CLEMSON SPORTS MEDICINE AND REHABILITATION
Authorized official
CHARLEEN FITZGERALD (CREDENTIALING)
(864) 482-0064
Entity
Organization
Contact information
Practice address
4237 RIVER HILLS DR, SUITE 120, LITTLE RIVER, SC 29566-6444
(843) 249-5616
(843) 249-1843
Mailing address
PO BOX 1844, CLEMSON, SC 29633-1844
(864) 482-0064
(864) 482-0081
Taxonomy
Speciality
Code
Description
License number
State
225XP0019X
Physical Rehabilitation Occupational Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
273Y00000X
Rehabilitation Hospital Unit
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5092260004
DMERC PROVIDER #
SC
Enumeration date
10/20/2006
Last updated
11/17/2014
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