Provider Demographics
NPI:1487641023
Name:HADDOX, ANNETTA L (PT)
Entity Type:Individual
Prefix:
First Name:ANNETTA
Middle Name:L
Last Name:HADDOX
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 1:1729 N SHENANDOAH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-3643
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3127 VALLEY AVENU
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2635
Practice Address - Country:US
Practice Address - Phone:540-667-1800
Practice Address - Fax:540-667-3839
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00V897P01Medicare PIN