MRS. CRYSTAL LEIGH MADDOX (NPI# 1295374643) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295374643 |
| Entity Type | Individual |
| Full Name | MRS. CRYSTAL LEIGH MADDOX |
| Credential | MPT |
| Practice Address |
200 Medical Park Blvd Petersburg VA 23805-9274 |
| Mailing Address |
11104 Courthouse Rd Waverly VA 23890-4422 |
| Practice Telephone | 8047655000 |
| Enumeration Date | 2020-01-02 |
| Last Update Date | 2020-01-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2251G0304X |
Physical Therapist Specialization: Geriatrics |
PT028240 | PA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
200 MEDICAL PARK BLVD |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23805-9274 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902413636 | Delesa Shana Kay Walden | Registered Nurse | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-09-27 |
| 1992339436 | Amy Kathryn Lansing | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-02-24 |
| 1588296453 | Erin Elise Layne | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-02-10 |
| 1366081911 | Joshua Paul Pidcoe | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-12-31 |
| 1720623853 | Bon Secours Mercy Health Petersburg LLC | General Acute Care Hospital | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-11-13 |
| 1144874686 | Nina Thi Ong-pham | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-08-01 |
| 1720543507 | Martina Rochelle Washington | Specialist/Technologist, Other | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-02-05 |
| 1356812242 | Ams Virginia Pllc | Nurse Anesthetist, Certified Registered | 200 Medical Park Blvd, Petersburg, VA 23805 | 2018-12-17 |
| 1841761079 | Erin Collins | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2018-12-16 |
| 1265900260 | Casey Brennan | Nurse Practitioner | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2018-11-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134690647 | Miles Viant | Occupational Therapist | 287 E Blvd, Petersburg, VA 23805 | 2018-12-10 |
| 1245756964 | Dexter Shabazz Lett | Registered Nurse | 10543 S. Crater Rd, S. Prince George, VA 23805 | 2017-08-15 |
| 1891145876 | Taylor Enhanced Living | Counselor | 105 Holly Hill Dive, Suite A, Petersburg, VA 23805 | 2016-06-21 |
| 1700255205 | Ina Thompson | Counselor | 272 Medical Park Boulevard, Petersburg, VA 23805 | 2015-09-15 |
| 1932582541 | Valeria Edda Madrid Malo Bohorquez | Internal Medicine | 50 Medical Park Blvd Ste C, Petersburg, VA 23805 | 2015-06-30 |
| 1548642788 | Justin Andrew Phillingane | Podiatrist | 3335 S Crater Rd Ste 500, Petersburg, VA 23805 | 2015-06-24 |
| 1225417082 | Paladin Dermatology LLC | Nurse Practitioner | 44 A& B Medical Park Blvd, Petersburg, VA 23805 | 2015-05-27 |
| 1245652544 | Family Services Inc. | Health Maintenance Organization | 1045 Gustavo Lane, Petersburg, VA 23805 | 2014-01-06 |
| 1619268075 | Charlene Belangia | Massage Therapist | 3323 S. Crater Rd, Suite B, Petersburg, VA 23805 | 2011-04-20 |
| 1760709638 | Caresouth Hha Holdings of Virginia, LLC | Home Health | 34 Medical Park Boulevard, Suite G-h, Petersburg, VA 23805 | 2010-04-30 |
| Find all providers in zip 23805 | ||||
| Taxonomy Code | 2251G0304X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| Specialization | Geriatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891275012 | Betty Ann M Dubacher | Physical Therapist | 43 Red Pond Rd, Petersburg, NY 12138-5916 | 2018-08-16 |
| 1891827804 | Valerie Black | Physical Therapist | 27 Early Ave, Petersburg, WV 26847-9403 | 2007-03-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568935849 | Joel Manalang Polintan Jr. | Physical Therapist | 171 Cedarwalk Circle, Leesburg, VA 20176 | 2019-01-09 |
| 1023538444 | Kathryn Marie Logsdon | Physical Therapist | 2900 Calcutt Drive, Midlothian, VA 23113 | 2017-06-27 |
| 1215390042 | Debbie Flint | Physical Therapist | 4416 Rockcrest Dr, Fairfax, VA 22032-1820 | 2016-03-30 |
| 1043670425 | Yeorgia Ackles | Physical Therapist | 20127 Hardwood Ter, Ashburn, VA 20147-2754 | 2016-02-29 |
| 1194183913 | Teresa Eileen Datz-kinahan | Physical Therapist | 3020 Summerhurst Dr, Midlothian, VA 23113-2181 | 2016-02-08 |
| 1184000226 | Valeria Paola Niehaus | Physical Therapist | 2029 Lockwood Dr, Charlottesville, VA 22911-5614 | 2015-07-30 |
| 1649659897 | Genaro Pantangco | Physical Therapist | 8447 Hallie Rose St, Alexandria, VA 22309-4516 | 2015-05-20 |
| 1558789321 | Sheryl Finucane | Physical Therapist | 140 Lake Caroline Dr, Ruther Glen, VA 22546-5220 | 2014-03-31 |
| 1548601529 | Whitney C Pelton | Physical Therapist | 5910 Wilson Blvd, Sunrise Bluemont, Arlington, VA 22205 | 2013-07-08 |
| 1598006488 | Ashley Ballentine Mumaw | Physical Therapist | 390 Hill Top Ct, Front Royal, VA 22630-4664 | 2013-03-03 |
| Find all providers with the same taxonomy | ||||
| City | PETERSBURG |
| Zip Code | 23805 |
Please comment or provide details below to improve the information on MRS. CRYSTAL LEIGH MADDOX.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.