Healthcare Provider Details

I. General information

NPI: 1821194929
Provider Name (Legal Business Name): CLEMSON SPORTS MEDICINE AND REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 FARROW RD SUITE 100
COLUMBIA SC
29203-7607
US

IV. Provider business mailing address

PO BOX 1844
CLEMSON SC
29633-1844
US

V. Phone/Fax

Practice location:
  • Phone: 803-771-1535
  • Fax:
Mailing address:
  • Phone: 864-482-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STUART L. HUNTER
Title or Position: OWNER
Credential: PT
Phone: 864-482-0064