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General NPI Number Information
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NPI Number | 1659160141
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Entity Type | Individual
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Provider Name | AHMAAD JAHSHUA BASTIEN DPT
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Gender | Male
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Dates
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Enumeration Date | 05/02/2025
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 710 S ANN ST
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City | BALTIMORE
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State | MD
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Zip | 21231-3401
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Country | US
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Telephone | 667-401-8847
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Fax |
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Provider Business Mailing Address
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Address Line | 8404 GREENS LN
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City | WINDSOR MILL
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State | MD
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Zip | 21244-1120
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Country | US
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Telephone | 443-739-9292
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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 | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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