Individual provider Active NPI

Maddison Lea McQuillen, DPT, PT

  • Physical Therapist
  • Herndon, VA
National Provider Identifier
1528536968
Registry record updated Dec 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305212491 Issued in VA
Practice address
13039 Worldgate Dr
Herndon, VA 20170-4374
Phone
(703) 689-3164
Fax
(703) 689-3167
NPI assigned
Nov 4, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2305212491 VA Primary

Addresses

Primary practice location

13039 Worldgate Dr
Herndon, VA 20170-4374

Mailing address

PO Box 1769
Middleburg, VA 20118-1769

Other practice location 1

46161 Westlake Dr Ste 330
Sterling, VA 20165-5871
Phone (703) 444-9562

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210526000290 FL Practitioner - Physical Therapist in Private Practice 9436495678 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Healthpro Heritage Rehab & Fitness, LLC Physical Therapist CurrentSince Apr 5, 2025 Accepting new patients
Empath Therapies, LLC Physical Therapist CurrentSince Nov 1, 2021 Accepting new patients
Healthpro Heritage Rehab & Fitness, LLC Physical Therapist CurrentSince Apr 5, 2025 Accepting new patients
The Jackson Clinics LLC Physical Therapist PastSince Dec 16, 2019 Accepting new patients

Locations

5955 Rand Blvd
Sarasota, FL 34238
Phone (941) 552-7500

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1541289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575936000000",
    "number": "1528536968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1769",
            "city": "MIDDLEBURG",
            "state": "VA",
            "postal_code": "201181769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13039 WORLDGATE DR",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201704374",
            "telephone_number": "703-689-3164",
            "fax_number": "703-689-3167"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "46161 Westlake Dr Ste 330",
            "address_purpose": "LOCATION",
            "city": "Sterling",
            "state": "VA",
            "postal_code": "201655871",
            "country_code": "US",
            "telephone_number": "703-444-9562",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCQUILLEN",
        "first_name": "MADDISON",
        "middle_name": "LEA",
        "credential": "DPT, PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-04",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305212491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Herndon, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.