Provider Demographics
NPI:1336362268
Name:MOSADDEGH PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MOSADDEGH PHYSICAL THERAPY
Other - Org Name:PHYSICAL THERAPY AND SPORTS MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOHAILA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSADDEGH MEHJARDI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-446-1644
Mailing Address - Street 1:7500 HANOVER PARKWAY
Mailing Address - Street 2:SUITE 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 1:1100 MERCANTILE LANE
Practice Address - Street 2:SUITE 135
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774
Practice Address - Country:US
Practice Address - Phone:301-772-2202
Practice Address - Fax:301-772-3018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
490853Medicare ID - Type Unspecified