Provider Demographics
NPI:1821359506
Name:MASSOUD TALAIE, RPT INC
Entity Type:Organization
Organization Name:MASSOUD TALAIE, RPT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MASSOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:TALAIE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:301-897-9187
Mailing Address - Street 1:6410 ROCKLEDGE DR
Mailing Address - Street 2:SUITE 309
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1809
Mailing Address - Country:US
Mailing Address - Phone:301-897-9187
Mailing Address - Fax:301-530-4120
Practice Address - Street 1:6410 ROCKLEDGE DR
Practice Address - Street 2:SUITE 309
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1809
Practice Address - Country:US
Practice Address - Phone:301-897-9187
Practice Address - Fax:301-530-4120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1508939448OtherNPI1
MD048884400Medicaid