Provider Demographics
NPI:1659398006
Name:MADDOCKS, RALPH MICHAEL (PT MS OCS)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:MICHAEL
Last Name:MADDOCKS
Suffix:
Gender:M
Credentials:PT MS OCS
Other - Prefix:
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Mailing Address - Street 1:3515 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4934
Mailing Address - Country:US
Mailing Address - Phone:919-781-4060
Mailing Address - Fax:919-781-5246
Practice Address - Street 1:3515 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4934
Practice Address - Country:US
Practice Address - Phone:919-781-4060
Practice Address - Fax:919-781-5246
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5576225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078WCOtherBCBS NC
NC836265OtherUHC ACN MPN
NC3075129OtherAETNA HMO
NC6698919OtherGHI
NC5658651OtherAETNA PPO
NC4872760OtherUHC ACN MPN
NC6698919OtherGHI