Provider Demographics
NPI:1023377603
Name:NIKSERESHT, ZAHRA SUSAN (MASTERS DEGREE)
Entity Type:Individual
Prefix:
First Name:ZAHRA
Middle Name:SUSAN
Last Name:NIKSERESHT
Suffix:
Gender:F
Credentials:MASTERS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 EXECUTIVE BLV # 510
Mailing Address - Street 2:NOT APPLICABLE
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-770-7900
Mailing Address - Fax:301-770-7904
Practice Address - Street 1:6000 EXECUTIVE BLVD STE 510
Practice Address - Street 2:NOT APPLICABLE
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3830
Practice Address - Country:US
Practice Address - Phone:301-770-7900
Practice Address - Fax:301-770-7904
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist