Provider Demographics
NPI:1487724217
Name:HORIZON REHABILITATION AND SPORTS MEDICINE, LLC
Entity type:Organization
Organization Name:HORIZON REHABILITATION AND SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:843-671-7342
Mailing Address - Street 1:8 HOSPITAL CENTER BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-8700
Mailing Address - Country:US
Mailing Address - Phone:843-671-7342
Mailing Address - Fax:843-671-7343
Practice Address - Street 1:8 HOSPITAL CENTER BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-8700
Practice Address - Country:US
Practice Address - Phone:843-671-7342
Practice Address - Fax:843-671-7343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC225X00000X, 225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00372669OtherDF5263
SCP00600165OtherDF5263
SCP00372665OtherDF5263
SCP00372669OtherDF5263