=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770740664
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAROLINA SPINE AND SPORT REHABILIATATION SPECIALIST,P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2008
-----------------------------------------------------
Last Update Date | 02/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 763 TRAVELERS BLVD STE D
-----------------------------------------------------
City | SUMMERVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29485-8796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-569-5421
-----------------------------------------------------
Fax | 843-569-5973
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 763 TRAVELERS BLVD STE D
-----------------------------------------------------
City | SUMMERVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29485-8796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-569-5421
-----------------------------------------------------
Fax | 843-569-5973
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NANCY ROSE LEMBO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 843-569-5421
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 918
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------