Provider Demographics
NPI:1184828162
Name:SHABAZZ, ELIZABETH MICHELE (PT)
Entity Type:Individual
Prefix:MR
First Name:ELIZABETH
Middle Name:MICHELE
Last Name:SHABAZZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15608 HEXHAM TER
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8024
Mailing Address - Country:US
Mailing Address - Phone:301-985-3222
Mailing Address - Fax:301-209-2976
Practice Address - Street 1:4409 E WEST HWY
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1058
Practice Address - Country:US
Practice Address - Phone:301-699-2000
Practice Address - Fax:301-209-2976
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist