Provider Demographics
NPI:1205175825
Name:MOID, MOHAMMED (NCTMB)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:MOID
Suffix:
Gender:M
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3089 W FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-8504
Mailing Address - Country:US
Mailing Address - Phone:317-881-8700
Mailing Address - Fax:
Practice Address - Street 1:3089 W FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-8504
Practice Address - Country:US
Practice Address - Phone:317-881-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT21204239225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist