MEDICARE: HADJIRA MOUDJED PTA

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	225200000X	Physical Therapy Assistant	PTA09861	OH

General Provider Information

NPI Number	:	1821773094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HADJIRA MOUDJED PTA

Provider Business Mailing Address
First Line	:	155 HOLLYTREE DR
Second Line	:
City	:	MONROE
State	:	OH
Zip	:	45044-3362
Country	:	US
Telephone Number	:	937-524-6841
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 HOLLYTREE DR
Second Line	:
City	:	MONROE
State	:	OH
Zip	:	45044-3362
Country	:	US
Telephone Number	:	937-524-6841
Fax Number	:

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

Provider Enumeration Date	:	06/16/2023
Last Update Date	:	06/16/2023

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Directions to “ HADJIRA MOUDJED PTA” Practice Location

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