Active NPI
Crystal Leigh Maddox, MPT
- Geriatric Physical Therapist
- Petersburg, VA
National Provider Identifier
1295374643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- PT028240
- Practice address
- 200 Medical Park Blvd
Petersburg, VA 23805-9274 - Phone
- (804) 765-5000
- NPI assigned
- Jan 2, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | PT028240 | PA | Primary |
Addresses
Primary practice location
200 Medical Park Blvd
Petersburg, VA 23805-9274
Mailing address
11104 Courthouse Rd
Waverly, VA 23890-4422
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT028240 | PA | MD | Geriatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1577923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1577923200000",
"number": "1295374643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11104 COURTHOUSE RD",
"city": "WAVERLY",
"state": "VA",
"postal_code": "238904422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 MEDICAL PARK BLVD",
"city": "PETERSBURG",
"state": "VA",
"postal_code": "238059274",
"telephone_number": "804-765-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADDOX",
"first_name": "CRYSTAL",
"middle_name": "LEIGH",
"name_prefix": "Mrs.",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-02",
"last_updated": "2020-01-02",
"certification_date": "2020-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "PA",
"license": "PT028240",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petersburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.