Provider Demographics
NPI:1922297571
Name:MAGID-SLAV, MODI (MPT)
Entity Type:Individual
Prefix:MR
First Name:MODI
Middle Name:
Last Name:MAGID-SLAV
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 GENERAL ARMSTRONG RD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1642
Mailing Address - Country:US
Mailing Address - Phone:610-203-4917
Mailing Address - Fax:215-750-4328
Practice Address - Street 1:610 GENERAL ARMSTRONG RD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1642
Practice Address - Country:US
Practice Address - Phone:610-203-4917
Practice Address - Fax:215-750-4328
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist