Provider Demographics
NPI:1235722018
Name:MADDOX, KATHARINE P (PT)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:P
Last Name:MADDOX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 SPOTTSWOOD PL
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2323
Mailing Address - Country:US
Mailing Address - Phone:434-384-1410
Mailing Address - Fax:
Practice Address - Street 1:173 BROCKMAN PARK DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:VA
Practice Address - Zip Code:24521-2583
Practice Address - Country:US
Practice Address - Phone:434-946-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist