Provider Demographics
NPI:1508939448
Name:TALAIE, MASSOUD (RPT)
Entity Type:Individual
Prefix:
First Name:MASSOUD
Middle Name:
Last Name:TALAIE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 EXECUTIVE BLVD
Mailing Address - Street 2:STE 603
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3818
Mailing Address - Country:US
Mailing Address - Phone:301-717-8685
Mailing Address - Fax:240-465-0429
Practice Address - Street 1:6000 EXECUTIVE BLVD
Practice Address - Street 2:STE 603
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3818
Practice Address - Country:US
Practice Address - Phone:301-717-8685
Practice Address - Fax:240-465-0429
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD157892251S0007X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
186827Medicare ID - Type Unspecified