Healthcare Provider Details

I. General information

NPI: 1265831457
Provider Name (Legal Business Name): MAKQA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 GEORGIA AVE 200
SILVER SPRING MD
20902-5020
US

IV. Provider business mailing address

15714 OSTERLY LN
LEESBURG VA
20176-5831
US

V. Phone/Fax

Practice location:
  • Phone: 301-681-7880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAHBOOB CHAGHTAI
Title or Position: PRESIDENT
Credential:
Phone: 571-357-8288