Healthcare Provider Details

I. General information

NPI: 1821583154
Provider Name (Legal Business Name): MOSADDEGH PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17902 GEORGIA AVE STE 100
OLNEY MD
20832-1768
US

IV. Provider business mailing address

7500 HANOVER PKWY STE 103
GREENBELT MD
20770
US

V. Phone/Fax

Practice location:
  • Phone: 301-774-1789
  • Fax: 301-774-1394
Mailing address:
  • Phone: 301-446-1644
  • Fax: 301-446-1647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: SOHAILA MOSADDEGH
Title or Position: CEO
Credential: PT, DPT
Phone: 301-774-1789