Provider Demographics
NPI:1104184696
Name:HAGONA-WORDIE, RAYAN
Entity Type:Individual
Prefix:
First Name:RAYAN
Middle Name:
Last Name:HAGONA-WORDIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 55TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-6712
Mailing Address - Country:US
Mailing Address - Phone:832-818-2751
Mailing Address - Fax:
Practice Address - Street 1:714 55TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6712
Practice Address - Country:US
Practice Address - Phone:832-818-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27267225100000X
MD24773225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC871597OtherPT LICENSE NUMBER