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Individual

JEFF MADDOX

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
1901 MISSION 66, SUITE A, VICKSBURG, MS 39180-3711
(601) 638-4076
(601) 638-4979
Mailing address
PO BOX 822394, VICKSBURG, MS 39182-2394
(601) 638-4076
(601) 638-4979

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 1303
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
03701390
MS
Enumeration date
11/07/2006
Last updated
07/08/2007
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