Tara Maddox

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

8201 Henry Ave Apt K1
Philadelphia, PA 19128-2220

Phone

(215) 696-0888

NPI assigned

Jan 22, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548115200000",
    "number": "1043774219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 MILBOB DR",
            "city": "WARMINSTER",
            "state": "PA",
            "postal_code": "189741668",
            "telephone_number": "215-696-0888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8201 HENRY AVE APT K1",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191282220",
            "telephone_number": "215-696-0888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "JEFFERSON UNIVERSITY",
            "address_2": "4201 HENRY AVE",
            "address_purpose": "LOCATION",
            "city": "PHILADELPIA",
            "state": "PA",
            "postal_code": "19144",
            "country_code": "US",
            "telephone_number": "270-021-5951",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MADDOX",
        "first_name": "TARA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-22",
        "last_updated": "2019-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE",
            "identifier": "XOF823636392",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "XOF823636392",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maddie Budreau Therapy LLC
• Kavya Maddineni
• Maddox Behavioral Health Services
• Hillerie Black Maddox, LPC
• Sean A Maddox
• Victoria Maddox, LMT
• Srivarshini Maddukuri
• Swathi Maddula, M.D.
• Made Home Care
• Daria Viktorovna Madeeva, MD

• Athletic Trainer in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Athletic Trainer in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.