Provider Demographics
NPI:1467639153
Name:MADDUX, LEAH MARIE (PT)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:MADDUX
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 1:23110 FORD RD
Mailing Address - Street 2:STE. A
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-5416
Mailing Address - Country:US
Mailing Address - Phone:281-354-3383
Mailing Address - Fax:281-354-6750
Practice Address - Street 1:23110 FORD RD
Practice Address - Street 2:STE. A
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-5416
Practice Address - Country:US
Practice Address - Phone:281-354-3383
Practice Address - Fax:281-354-6750
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1172142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1172142OtherPHYSICAL THERAPY BOARD