Provider Demographics
NPI:1164838041
Name:MADDOX, JONI (DAT, ATC)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:
Last Name:MADDOX
Suffix:
Gender:F
Credentials:DAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NORTH WASHINGTON STREET
Mailing Address - Street 2:UWA STATION 14
Mailing Address - City:LIVINGSTON
Mailing Address - State:AL
Mailing Address - Zip Code:35470-6757
Mailing Address - Country:US
Mailing Address - Phone:205-365-3455
Mailing Address - Fax:
Practice Address - Street 1:100 NORTH WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:AL
Practice Address - Zip Code:35085-6757
Practice Address - Country:US
Practice Address - Phone:205-233-0932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer