Individual
TARA MADDOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8201 HENRY AVE APT K1, PHILADELPHIA, PA 19128-2220
(215) 696-0888
Mailing address
119 MILBOB DR, WARMINSTER, PA 18974-1668
(215) 696-0888
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XOF823636392
BLUE CROSS BLUE
PA
Enumeration date
01/22/2019
Last updated
01/22/2019
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