Provider Demographics
NPI:1033689823
Name:MOSADDEGH PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:MOSADDEGH PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SASAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALEZAMINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-446-1644
Mailing Address - Street 1:7500 HANOVER PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2011
Mailing Address - Country:US
Mailing Address - Phone:301-446-1644
Mailing Address - Fax:
Practice Address - Street 1:17902 GEORGIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2280
Practice Address - Country:US
Practice Address - Phone:301-774-1789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty