Healthcare Provider Details

I. General information

NPI: 1518270842
Provider Name (Legal Business Name): INTEGRATED SPORT, SPINE & REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9210 CORPORATE BLVD STE 345
ROCKVILLE MD
20850-6550
US

IV. Provider business mailing address

9210 CORPORATE BLVD STE 345
ROCKVILLE MD
20850-6550
US

V. Phone/Fax

Practice location:
  • Phone: 240-246-8880
  • Fax: 240-246-8881
Mailing address:
  • Phone: 240-246-8880
  • Fax: 240-246-8881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: BOBBAK MOZAFARI
Title or Position: OWNER
Credential: DC
Phone: 301-246-8880