42D1087629 CLIA NUMBER - CAROLINA SPINE & SPORT REHAB SPECIALISTS, PA

Laboratory Demographics

  • CLIA Code: 42D1087629
  • Facility Name: CAROLINA SPINE & SPORT REHAB SPECIALISTS, PA
  • Facility Address: 763 TRAVELERS BLVD, SUITE D & E
    SUMMERVILLE, SC
    ZIP 29485
  • Facility Phone: 843 569-5421
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NANCY R. LEMBO
  • NPI Number: 1053879007
  • Taxonomy: 101YP2500X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 42D1087629
LAB Type Physician Office
Facility Name CAROLINA SPINE & SPORT REHAB SPECIALISTS, PA
Street 763 TRAVELERS BLVD, SUITE D & E
City SUMMERVILLE
State SC
ZIP 29485
Phone 843 569-5421
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/8/2024
Certificate Expiration Date 8/7/2026
Facility Type Physician Office
Lab Director NANCY R. LEMBO

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This page was last updated on: 9/29/2025