Active NPI
Althaea Gracia Sotelo Madamba, PT
- Physical Therapist
- Wake Forest, NC
National Provider Identifier
1639346794
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 9320
- Practice address
- 6408 Canning PL
Wake Forest, NC 27587-4266 - Phone
- (919) 453-0793
- NPI assigned
- May 8, 2008
- Last updated
- May 8, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 9320 | NC | Primary |
Addresses
Primary practice location
6408 Canning PL
Wake Forest, NC 27587-4266
Mailing address
6408 Canning PL
Wake Forest, NC 27587-4266
Phone (919) 453-0793
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 |
|---|---|---|---|
| 9320 | NC | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210204800000",
"number": "1639346794",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6408 CANNING PL",
"city": "WAKE FOREST",
"state": "NC",
"postal_code": "275874266",
"telephone_number": "919-453-0793"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6408 CANNING PL",
"city": "WAKE FOREST",
"state": "NC",
"postal_code": "275874266",
"telephone_number": "919-453-0793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADAMBA",
"first_name": "ALTHAEA GRACIA",
"middle_name": "SOTELO",
"name_prefix": "Miss",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-08",
"last_updated": "2008-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "9320",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wake Forest, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.