Healthcare Provider Details

I. General information

NPI: 1891183612
Provider Name (Legal Business Name): CHRISTOPHER MADDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 ALTA ARDEN EXPY
SACRAMENTO CA
95825-2103
US

IV. Provider business mailing address

1812 DEVONSHIRE RD
SACRAMENTO CA
95864-1505
US

V. Phone/Fax

Practice location:
  • Phone: 916-481-5500
  • Fax:
Mailing address:
  • Phone: 916-342-5488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT3940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: