Provider Demographics
NPI:1821773094
Name:MOUDJED, HADJIRA (PTA)
Entity Type:Individual
Prefix:
First Name:HADJIRA
Middle Name:
Last Name:MOUDJED
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 HOLLYTREE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45044-3362
Mailing Address - Country:US
Mailing Address - Phone:937-524-6841
Mailing Address - Fax:
Practice Address - Street 1:155 HOLLYTREE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:OH
Practice Address - Zip Code:45044-3362
Practice Address - Country:US
Practice Address - Phone:937-524-6841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA09861225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant