Provider Demographics
NPI:1083942031
Name:DAMDAR, ASHA INDIRA (PT)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:INDIRA
Last Name:DAMDAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6945 MAYFAIR TERRACE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707
Mailing Address - Country:US
Mailing Address - Phone:301-604-3901
Mailing Address - Fax:
Practice Address - Street 1:6945 MAYFAIR TER
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5215
Practice Address - Country:US
Practice Address - Phone:301-604-3901
Practice Address - Fax:301-604-3901
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist