Individual
MADELINE MAYNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
5500 FRONT ST STE 203, SUMMERVILLE, SC 29486-8137
(843) 879-4060
Mailing address
PO BOX 530062, ATLANTA, GA 30353-0062
(763) 348-2075
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
CP051004T
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1373833
PHYSICAL THERAPY LICENSE
TX
05
—
TH6715
—
SC
Enumeration date
04/21/2026
Last updated
08/04/2026
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