Organization
SPORTS PLUS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE MAYNARD (PTA)
(803) 649-9975
Entity
Organization
Contact information
Practice address
170 UNIVERSITY PKWY, AIKEN, SC 29801-6308
(803) 649-9975
Mailing address
1009 TOOLEBECK RD, AIKEN, SC 29803-9679
(803) 644-2020
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA.1861
SC
Other
Enumeration date
12/20/2006
Last updated
08/22/2020
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