Healthcare Provider Details

I. General information

NPI: 1164422960
Provider Name (Legal Business Name): MAURYA APPLEGATE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7580 CHARLOTTE HWY STE 1100
FORT MILL SC
29707-7803
US

IV. Provider business mailing address

2145 FLICKER RD
INDIAN LAND SC
29707-6217
US

V. Phone/Fax

Practice location:
  • Phone: 813-777-6281
  • Fax:
Mailing address:
  • Phone: 813-777-6281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8618
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP16191
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: