| Organization Name: | CLEMSON SPORTS MEDICINE AND REHABILITATION, INC. |
| NPI Number: | 1851527261 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEBBIE BAXTER (CREDENTIALING) |
| Mailing Address: | 210 Village Center Blvd Ste 100 Myrtle Beach |
| State: | SC US |
| Postal Code: | 295796706 |
| Phone Number: | 8434914937 |
| Fax Number: | 8434914938 |
| NPI Enumeration Date: | 06/01/2009 |
| NPI Last Update Date: | 04/28/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |