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General NPI Number Information
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NPI Number | 1225844368
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Entity Type | Individual
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Provider Name | MOHAMMAD MONIR HOSSAIN PTA
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Gender | Male
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 1298 INTERSTATE PKWY
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City | AUGUSTA
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State | GA
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Zip | 30909-6480
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Country | US
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Telephone | 706-868-1707
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Fax |
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Provider Business Mailing Address
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Address Line | 9008 SUNRIDGE CIR APT 1226
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City | FORT WORTH
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State | TX
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Zip | 76120-4750
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Country | US
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Telephone | 203-360-5173
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | CPO38462A
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License Number State | GA
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