Provider Demographics
NPI:1659866994
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:SOHAILA
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:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770
Mailing Address - Country:US
Mailing Address - Phone:301-446-1644
Mailing Address - Fax:301-446-1647
Practice Address - Street 1:6510 KENILWORTH AVE
Practice Address - Street 2:STE 2200
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1339
Practice Address - Country:US
Practice Address - Phone:240-770-8750
Practice Address - Fax:240-770-8156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
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