Provider Demographics
NPI:1144248279
Name:KING, LOUANN MADDOX (PT)
Entity type:Individual
Prefix:
First Name:LOUANN
Middle Name:MADDOX
Last Name:KING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5337 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:CHINCOTEAGUE
Mailing Address - State:VA
Mailing Address - Zip Code:23336-2111
Mailing Address - Country:US
Mailing Address - Phone:757-336-5134
Mailing Address - Fax:
Practice Address - Street 1:6751 MADDOX BLVD
Practice Address - Street 2:
Practice Address - City:CHINCOTEAGUE
Practice Address - State:VA
Practice Address - Zip Code:23336-2253
Practice Address - Country:US
Practice Address - Phone:757-336-5134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202397225100000X
MD21467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist