Provider Demographics
NPI:1417564956
Name:HEDAYAT, LENA
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:HEDAYAT
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 1:64-974 MAMALAHO HWY
Mailing Address - Street 2:STE 103
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-7334
Mailing Address - Country:US
Mailing Address - Phone:310-919-8746
Mailing Address - Fax:
Practice Address - Street 1:6196 OXON HILL RD STE 450
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3173
Practice Address - Country:US
Practice Address - Phone:301-839-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-5248-0225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist