Healthcare Provider Details

I. General information

NPI: 1063647717
Provider Name (Legal Business Name): MELVIN ELLIOTT GADSON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1195 BOARDWALK
SUMTER SC
29150-1767
US

IV. Provider business mailing address

1195 BOARDWALK
SUMTER SC
29150-1767
US

V. Phone/Fax

Practice location:
  • Phone: 803-840-3734
  • Fax: 803-469-8830
Mailing address:
  • Phone: 803-840-3734
  • Fax: 803-883-4960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4295
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: