Provider Demographics
NPI:1518270842
Name:INTEGRATED SPORT, SPINE & REHAB
Entity Type:Organization
Organization Name:INTEGRATED SPORT, SPINE & REHAB
Other - Org Name:INTEGRATED SSR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:BOBBAK
Authorized Official - Middle Name:
Authorized Official - Last Name:MOZAFARI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-570-7970
Mailing Address - Street 1:6860 OLNEY LAYTONSVILLE RD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:LAYTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20882-1921
Mailing Address - Country:US
Mailing Address - Phone:301-570-7970
Mailing Address - Fax:301-570-7971
Practice Address - Street 1:6860 OLNEY LAYTONSVILLE RD UNIT 3
Practice Address - Street 2:
Practice Address - City:LAYTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20882-1921
Practice Address - Country:US
Practice Address - Phone:301-570-7970
Practice Address - Fax:301-570-7971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03751111NR0400X
208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty