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Individual
STEPHANIE LEAKE MADDOX
Active
Individual
STEPHANIE LEAKE MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5134
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05430071
—
MS
05
—
110318002
—
AR
05
—
1512616
—
TN
05
—
3371161
—
TN
01
—
4161223
BCBS
TN
01
—
620819926
BCBS
MS
01
—
620819926
AETNA
TN
05
—
7187860
—
MS
01
—
9101087
AETNA
TN
Enumeration date
10/12/2007
Last updated
03/25/2011
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