Provider Demographics
NPI:1598055071
Name:MADDEN, LURA BLAIR (DPT)
Entity Type:Individual
Prefix:
First Name:LURA
Middle Name:BLAIR
Last Name:MADDEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6344 HIBISCUS CT
Mailing Address - Street 2:
Mailing Address - City:WHITSETT
Mailing Address - State:NC
Mailing Address - Zip Code:27377-9295
Mailing Address - Country:US
Mailing Address - Phone:919-866-9466
Mailing Address - Fax:
Practice Address - Street 1:6344 HIBISCUS CT
Practice Address - Street 2:
Practice Address - City:WHITSETT
Practice Address - State:NC
Practice Address - Zip Code:27377-9295
Practice Address - Country:US
Practice Address - Phone:919-866-9466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist