Healthcare Provider Details

I. General information

NPI: 1295648384
Provider Name (Legal Business Name): YUSUF A SIDDIQUI PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 E GUDE DR STE 200
ROCKVILLE MD
20850-1371
US

IV. Provider business mailing address

17902 GEORGIA AVE STE 220
OLNEY MD
20832-2279
US

V. Phone/Fax

Practice location:
  • Phone: 240-774-0222
  • Fax: 240-774-0223
Mailing address:
  • Phone: 240-774-0222
  • Fax: 240-774-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA5776
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: