Provider Demographics
NPI:1912507302
Name:BILLS, MADELINE JOANNA
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:JOANNA
Last Name:BILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 LOCUST GROVE DR
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-3391
Mailing Address - Country:US
Mailing Address - Phone:703-470-4459
Mailing Address - Fax:
Practice Address - Street 1:308 LOCUST GROVE DR
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-3391
Practice Address - Country:US
Practice Address - Phone:703-470-4459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer