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General NPI Number Information
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NPI Number | 1285874438
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Entity Type | Individual
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Provider Name | ALEXANDER DEMOZ HAILEMELEKOT PHYSICAL THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 03/01/2009
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Last Update Date | 03/01/2009
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Provider Practice Location Address
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Address Line | 101 CENTENNIAL ST SUITE 101
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City | LA PLATA
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State | MD
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Zip | 20646-5975
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Country | US
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Telephone | 301-392-3700
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Fax | 301-392-3876
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Provider Business Mailing Address
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Address Line | 708 13TH ST NE APT. A
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City | WASHINGTON
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State | DC
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Zip | 20002-4412
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Country | US
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Telephone | 720-220-7610
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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 | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | 22828
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License Number State | MD
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