Provider Demographics
NPI:1801059779
Name:PALMETTO MEDICAL REHABILITATION
Entity type:Organization
Organization Name:PALMETTO MEDICAL REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONDA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-284-9850
Mailing Address - Street 1:PO BOX 50087
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-0019
Mailing Address - Country:US
Mailing Address - Phone:864-330-1666
Mailing Address - Fax:864-330-1870
Practice Address - Street 1:1530 PARKWAY
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646
Practice Address - Country:US
Practice Address - Phone:817-284-9850
Practice Address - Fax:864-330-1870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDO 720208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DO2951Medicare PIN
SC9035Medicare PIN
SCH82261Medicare UPIN