Provider Demographics
NPI:1033083761
Name:MADDOX, MARQUETTA (LMT)
Entity type:Individual
Prefix:MS
First Name:MARQUETTA
Middle Name:
Last Name:MADDOX
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 SUMTER HEIGHTS CT APT 2001
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-6719
Mailing Address - Country:US
Mailing Address - Phone:919-523-1310
Mailing Address - Fax:
Practice Address - Street 1:7610 SUMTER HEIGHTS CT APT 2001
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-6719
Practice Address - Country:US
Practice Address - Phone:919-523-1310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-04
Last Update Date:2025-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22841225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist