MEDICARE: MADISON KING PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	13218	SC

General Provider Information

NPI Number	:	1710839188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON KING PT

Provider Business Mailing Address
First Line	:	6705 WHITE HORSE RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-2503
Country	:	US
Telephone Number	:	704-654-8599
Fax Number	:	980-938-6088

Provider Business Practice Location Address
First Line	:	6705 WHITE HORSE RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-2503
Country	:	US
Telephone Number	:	704-654-8599
Fax Number	:	980-938-6088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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Directions to “ MADISON KING PT” Practice Location

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