Provider Demographics
NPI:1922771807
Name:MAXEY, MADISON CAMARIE (PTA)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:CAMARIE
Last Name:MAXEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11277 DUBLIN RD
Mailing Address - Street 2:
Mailing Address - City:WOODSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21798-9004
Mailing Address - Country:US
Mailing Address - Phone:240-385-4652
Mailing Address - Fax:
Practice Address - Street 1:205 S CHURCH ST STE B
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:MD
Practice Address - Zip Code:21769-8144
Practice Address - Country:US
Practice Address - Phone:301-371-8121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5439225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA5439OtherMARYLAND DEPARTMENT OF HEALTH