NPIMap

Organization Active NPI

Coastal Clemson Enterprise LLC

  • Physical Therapist
  • Moncks Corner, SC
National Provider Identifier
1144934266
Registry record updated Jan 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
COASTAL CLEMSON ENTERPRISE LLC
Practice address
115 Cooks Rest LN
Moncks Corner, SC 29461-8895
Phone
(678) 978-2395
NPI assigned
Jan 12, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nathan Clemson, PT
Title
Owner
Phone
(678) 978-2395

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

115 Cooks Rest LN
Moncks Corner, SC 29461-8895

Mailing address

115 Cooks Rest LN
Moncks Corner, SC 29461-8895
Phone (678) 978-2395

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1673481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673481600000",
    "number": "1144934266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 COOKS REST LN",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294618895",
            "telephone_number": "678-978-2395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 COOKS REST LN",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294618895",
            "telephone_number": "678-978-2395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CLEMSON ENTERPRISE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-12",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A",
        "authorized_official_last_name": "CLEMSON",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-978-2395",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moncks Corner, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.