NPIMap

Organization Active NPI

Clemson Sports Medicine and Rehabilitation

Doing business as Myrtle Beach Physical Therapy

  • Rehabilitation Hospital Unit
  • Little River, SC
National Provider Identifier
1720160450
Registry record updated Nov 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
Legal business name
CLEMSON SPORTS MEDICINE AND REHABILITATION
Doing business as
Myrtle Beach Physical Therapy
Practice address
4237 River Hills Dr
Suite 120
Little River, SC 29566-6444
Phone
(843) 249-5616
Fax
(843) 249-1843
NPI assigned
Oct 20, 2006
Last updated
Nov 17, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
CLEMSON SPORTS MEDICINE AND REHABILITATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 17, 2014

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

Authorized official

Name
Charleen Fitzgerald
Title
Credentialing
Phone
(864) 482-0064

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU
Rehabilitation Hospital Unit 273Y00000X NU Primary
Prosthetic/Orthotic Supplier 335E00000X NU
Physical Rehabilitation Occupational Therapist 225XP0019X NU

Addresses

Primary practice location

4237 River Hills Dr
Suite 120
Little River, SC 29566-6444

Mailing address

PO Box 1844
Clemson, SC 29633-1844
Phone (864) 482-0064

Other identifiers 1

IdentifierTypeStateIssuer
5092260004OtherSCDMERC PROVIDER #

Other names 1

  • Myrtle Beach Physical Therapy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Clemson Sports Medicine35 organizations share this tax ID, including this one
Part of
Clemson Sports Medicine

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416182400000",
    "number": "1720160450",
    "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": "4237 RIVER HILLS DR",
            "address_2": "SUITE 120",
            "city": "LITTLE RIVER",
            "state": "SC",
            "postal_code": "295666444",
            "telephone_number": "843-249-5616",
            "fax_number": "843-249-1843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEMSON SPORTS MEDICINE AND REHABILITATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLEMSON SPORTS MEDICINE AND REHABILITATION",
        "enumeration_date": "2006-10-20",
        "last_updated": "2014-11-17",
        "status": "A",
        "authorized_official_last_name": "FITZGERALD",
        "authorized_official_first_name": "CHARLEEN",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "864-482-0064"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0019X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC PROVIDER #",
            "identifier": "5092260004",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Myrtle Beach Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Little River, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2014; 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.