Provider Demographics
NPI:1952735763
Name:MORAGAHAKUMBURA, IONIE AMALI (DPT)
Entity Type:Individual
Prefix:
First Name:IONIE
Middle Name:AMALI
Last Name:MORAGAHAKUMBURA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 UNIVERSITY BLVD W
Mailing Address - Street 2:310
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1905
Mailing Address - Country:US
Mailing Address - Phone:301-942-7600
Mailing Address - Fax:301-942-6998
Practice Address - Street 1:2730 UNIVERSITY BLVD W
Practice Address - Street 2:SUITE 714
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-1905
Practice Address - Country:US
Practice Address - Phone:301-942-7600
Practice Address - Fax:301-942-6998
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist