Clemson Sports Medicine and Rehabilitation, Inc

Primary specialty

Rehabilitation Hospital UnitTaxonomy code 273Y00000X

Legal business name

CLEMSON SPORTS MEDICINE AND REHABILITATION, INC

Practice address

217A Saint James Ave
Goose Creek, SC 29445-2990

Phone

(843) 531-5495

Fax

(843) 277-6232

NPI assigned

May 21, 2013

Organization subpart

Yes

Parent organization

CLEMSON SPORTS MEDICINE AND REHABILITATION, INCAs reported in NPPES

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

Authorized official

Name

Jennifer McQuillen

Title

Credentialing

Phone

(864) 482-0064

Specialties & licenses 2

Addresses

Other names 1

• Goose Creek Physical Therapy Doing business as

Part of

Clemson Sports Medicine

Locations

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

{
    "created_epoch": "1369094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457481600000",
    "number": "1689010308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1844",
            "city": "CLEMSON",
            "state": "SC",
            "postal_code": "296331844",
            "telephone_number": "864-482-0064",
            "fax_number": "864-482-0081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217A SAINT JAMES AVE",
            "city": "GOOSE CREEK",
            "state": "SC",
            "postal_code": "294452990",
            "telephone_number": "843-531-5495",
            "fax_number": "843-277-6232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEMSON SPORTS MEDICINE AND REHABILITATION, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLEMSON SPORTS MEDICINE AND REHABILITATION, INC",
        "enumeration_date": "2013-05-21",
        "last_updated": "2016-03-09",
        "status": "A",
        "authorized_official_last_name": "MCQUILLEN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "864-482-0064"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goose Creek Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chih Tien Chuang, PHARM.D.
• Brian Ciaccia, PT, DPT
• City of Goose Creek
• Claire Brooke Sleep Center LLC
• Jeannine M Clearman, LMT
• Tanner Cline
• Coastal Internal Medicine & Geriatrics LLC
• Coastal Therapy Services, Inc.
• Coastal Vision Care LLC
• Kennasia Coaxum

• Rehabilitation Hospital Unit in Goose Creek, SC
• Providers in Goose Creek, SC by specialty
• Rehabilitation Hospital Unit in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2016; 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.