Provider Demographics
NPI:1063256410
Name:SEYED-ALI, MINA (PT, DPT)
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:SEYED-ALI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 POOKS HILL RD APT 116N
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-6737
Mailing Address - Country:US
Mailing Address - Phone:240-565-9152
Mailing Address - Fax:
Practice Address - Street 1:4980 WYACONDA RD STE A-B
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-2468
Practice Address - Country:US
Practice Address - Phone:301-298-9868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist