Provider Demographics
NPI:1508530411
Name:STAMPLEY, MADDOX GRAY (DPT)
Entity Type:Individual
Prefix:
First Name:MADDOX
Middle Name:GRAY
Last Name:STAMPLEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 N JUDD PKWY NE STE 100
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-1989
Mailing Address - Country:US
Mailing Address - Phone:919-896-7158
Mailing Address - Fax:919-896-7208
Practice Address - Street 1:704 N JUDD PKWY NE STE 100
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-1989
Practice Address - Country:US
Practice Address - Phone:919-896-7158
Practice Address - Fax:919-896-7208
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20598225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty