Healthcare Provider Details

I. General information

NPI: 1578347415
Provider Name (Legal Business Name): HEENA KALATHIYA PT,MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3165 CRAIN HWY STE 100
WALDORF MD
20603-4847
US

IV. Provider business mailing address

307 5TH AVE FL 6
NEW YORK NY
10016-6575
US

V. Phone/Fax

Practice location:
  • Phone: 301-885-2500
  • Fax:
Mailing address:
  • Phone: 212-759-2282
  • Fax: 212-379-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number050435
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30178
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: