Healthcare Provider Details

I. General information

NPI: 1881850634
Provider Name (Legal Business Name): CLEMSON SPORTS MEDICINE AND REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 STAMP CREEK RD
SALEM SC
29676-4516
US

IV. Provider business mailing address

PO BOX 1844
CLEMSON SC
29633-1844
US

V. Phone/Fax

Practice location:
  • Phone: 864-944-5146
  • Fax: 864-944-5147
Mailing address:
  • Phone: 864-482-0064
  • Fax: 864-482-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

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