Provider Demographics
NPI:1457838682
Name:MOSADDEGH PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:MOSADDEGH PHYSICAL THERAPY INC
Other - Org Name:PHYSICAL THERAPY SPORTS MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SOHALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSADDEGH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:301-774-1789
Mailing Address - Street 1:7500 HANOVER PKWY
Mailing Address - Street 2:STE. 103
Mailing Address - City:CREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-0000
Mailing Address - Country:US
Mailing Address - Phone:301-446-1644
Mailing Address - Fax:301-446-1647
Practice Address - Street 1:7301 E. FURNACE BRANCH RD.
Practice Address - Street 2:STE. A
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-1059
Practice Address - Country:US
Practice Address - Phone:443-422-3500
Practice Address - Fax:443-422-3513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty