Provider Demographics
NPI:1639212954
Name:MOSADDEGH - MEHJARDI, SOHAILA (PT)
Entity Type:Individual
Prefix:
First Name:SOHAILA
Middle Name:
Last Name:MOSADDEGH - MEHJARDI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SOHAILA
Other - Middle Name:
Other - Last Name:MOSADDEGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:7500 HANOVER PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2010
Mailing Address - Country:US
Mailing Address - Phone:301-446-1644
Mailing Address - Fax:301-446-1647
Practice Address - Street 1:7500 HANOVER PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2010
Practice Address - Country:US
Practice Address - Phone:301-446-1644
Practice Address - Fax:301-446-1647
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD178242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD490853Medicare ID - Type UnspecifiedPHYSICAL THERAPY