Individual
DR. MADISON DIANE TAVARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4105 FABER PLACE DR STE 420, NORTH CHARLESTON, SC 29405-8594
(843) 894-7374
Mailing address
17106 SWEET PL, CHARLESTON, SC 29492-2835
(781) 947-6556
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
13189
SC
225100000X
Physical Therapist
Primary
PT6321
ME
Other
Enumeration date
09/13/2022
Last updated
02/23/2026
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