Provider Demographics
NPI:1770740664
Name:CAROLINA SPINE AND SPORT REHABILIATATION SPECIALIST,P.A.
Entity type:Organization
Organization Name:CAROLINA SPINE AND SPORT REHABILIATATION SPECIALIST,P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:LEMBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-569-5421
Mailing Address - Street 1:763 TRAVELERS BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8796
Mailing Address - Country:US
Mailing Address - Phone:843-569-5421
Mailing Address - Fax:843-569-5973
Practice Address - Street 1:763 TRAVELERS BLVD STE D
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8796
Practice Address - Country:US
Practice Address - Phone:843-569-5421
Practice Address - Fax:843-569-5973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9182081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG49381Medicare UPIN
SC9014Medicare PIN