Edson Victor Madamba, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P19249 Issued in NC

Practice address

122 Branchwood Shopping Ctr
Jacksonville, NC 28546-5800

Phone

(910) 938-7555

NPI assigned

Dec 10, 2019

Last updated

Dec 10, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Jacksonville Peak Performance Sports & Physical Therapy, L.L.C.

  • Specialist
  • Jacksonville, NC
  • NPI 1164482402
  NPD

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

{
    "created_epoch": "1575936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575936000000",
    "number": "1821635863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2009 NEUSE BLVD",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285603470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 BRANCHWOOD SHOPPING CTR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285465800",
            "telephone_number": "910-938-7555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADAMBA",
        "first_name": "EDSON VICTOR",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-12-10",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P19249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Ryan Lytton, PA
• Sheila Anne Maaran, R.N.
• Samantha J Mabry
• Angela Everett Macdonald, O.D.
• Mad Chatter Psychotherapy & Sexology, PLLC
• Melissa Maddox, PTA, LMBT
• Darrin Eugene Madole, PT
• Benjamin Mithrandir Magleby
• Amber Simerly Magliocca, LMBT, CPT
• Sanjay Mahat, MD

• Physical Therapist in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Physical Therapist in North Carolina

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.