Basic Information
| Provider Information | |||||||||
| NPI: | 1487724217 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HORIZON REHABILITATION AND SPORTS MEDICINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 HOSPITAL CENTER BLVD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | HILTON HEAD ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299268700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436717342 | ||||||||
| FaxNumber: | 8436717343 | ||||||||
| Practice Location | |||||||||
| Address1: | 8 HOSPITAL CENTER BLVD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | HILTON HEAD ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299268700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436717342 | ||||||||
| FaxNumber: | 8436717343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 07/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | CLARK | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8436717342 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | 07/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | SC | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | SC | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.