Provider Demographics
NPI:1619781903
Name:PAWLEY, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:PAWLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OKATIE CENTER BLVD S STE 101
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7530
Mailing Address - Country:US
Mailing Address - Phone:843-705-9480
Mailing Address - Fax:
Practice Address - Street 1:38 SHERIDAN PARK CIR STE E
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7023
Practice Address - Country:US
Practice Address - Phone:843-757-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist