Provider Demographics
NPI:1659624096
Name:CLEMSON SPORTS MEDICINE AND REHABILITATION, INC.
Entity Type:Organization
Organization Name:CLEMSON SPORTS MEDICINE AND REHABILITATION, INC.
Other - Org Name:PINNACLE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-482-0064
Mailing Address - Street 1:PO BOX 1844
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29633-1844
Mailing Address - Country:US
Mailing Address - Phone:864-482-0064
Mailing Address - Fax:864-482-0081
Practice Address - Street 1:3250 FOREST DR
Practice Address - Street 2:STE 50
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4023
Practice Address - Country:US
Practice Address - Phone:803-726-0309
Practice Address - Fax:803-726-0390
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEMSON SPORTS MEDICINE AND REHABILITATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-23
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC426584Medicare Oscar/Certification