MEDICARE: BAILEY B R MADDOX LMT, CLT, CPT-NASM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	10303	SC

General Provider Information

NPI Number	:	1063292597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEY B R MADDOX LMT, CLT, CPT-NASM

Provider Business Mailing Address
First Line	:	1898 CALHOUN ST STE 8
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2650
Country	:	US
Telephone Number	:	803-200-1916
Fax Number	:

Provider Business Practice Location Address
First Line	:	1898 CALHOUN ST STE 8
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2650
Country	:	US
Telephone Number	:	803-200-1916
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	10/02/2023

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Directions to “ BAILEY B R MADDOX LMT, CLT, CPT-NASM” Practice Location

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