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NPI Code Detail

MEDICARE: MR. ELIZABETH MICHELE SHABAZZ PT

MEDICARE:  MR. ELIZABETH MICHELE SHABAZZ  PT
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
1225100000XPhysical Therapist15841MD

General Provider Information

NPI Number : 1184828162
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ELIZABETH MICHELE SHABAZZ PT
Provider Business Mailing Address
First Line : 15608 HEXHAM TER
Second Line :
City : UPPER MARLBORO
State : MD
Zip : 20774-8024
Country : US
Telephone Number : 301-985-3222
Fax Number : 301-209-2976
Provider Business Practice Location Address
First Line : 4409 E WEST HWY
Second Line :
City : RIVERDALE
State : MD
Zip : 20737-1058
Country : US
Telephone Number : 301-699-2000
Fax Number : 301-209-2976
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2007
Last Update Date : 07/08/2007

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Directions to “ MR. ELIZABETH MICHELE SHABAZZ PT” Practice Location

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