Provider Demographics
NPI:1356787006
Name:GOSAR, HENNA A (BPT)
Entity type:Individual
Prefix:MISS
First Name:HENNA
Middle Name:A
Last Name:GOSAR
Suffix:
Gender:F
Credentials:BPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 UPPER ROCK CIR
Mailing Address - Street 2:#463
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4239
Mailing Address - Country:US
Mailing Address - Phone:317-371-5129
Mailing Address - Fax:
Practice Address - Street 1:3227 BEL PRE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2423
Practice Address - Country:US
Practice Address - Phone:301-871-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist