MEDICARE: SATTA Y KANNEH DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	22801	MD

General Provider Information

NPI Number	:	1629219191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SATTA Y KANNEH DPT

Provider Business Mailing Address
First Line	:	12850 MIDDLEBROOK RD STE 307
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-5244
Country	:	US
Telephone Number	:	19-724-7523
Fax Number	:	304-972-4836

Provider Business Practice Location Address
First Line	:	12850 MIDDLEBROOK RD STE 307
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-5244
Country	:	US
Telephone Number	:	19-724-7523
Fax Number	:	304-972-4836

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2009
Last Update Date	:	09/20/2023

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