Healthcare Provider Details

I. General information

NPI: 1073759221
Provider Name (Legal Business Name): TEODROS HAILU PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 HUNTERS GATE CT
SILVER SPRING MD
20904-1827
US

IV. Provider business mailing address

26 HUNTERS GATE CT
SILVER SPRING MD
20904-1827
US

V. Phone/Fax

Practice location:
  • Phone: 240-393-6455
  • Fax:
Mailing address:
  • Phone: 240-393-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number20335
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: