Doctor Name: | JEFF MADDOX |
NPI Number: | 1487723946 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT |
License Number: | PT 1303 |
Business Practice Address: | 1901 Mission 66 Suite A Vicksburg, MS - 391803711 |
Business Phone Number: | 6016384076 |
Business Fax Number: | 6016384979 |
Mailing Address: | Po Box 822394, VICKSBURG |
State: | MS |
Postal Code: | 391822394 |
Phone Number: | 6016384076 |
Fax Number: | 6016384979 |
NPI Enumeration Date: | 11/07/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | PT 1303 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |