Provider Demographics
NPI:1225844368
Name:HOSSAIN, MOHAMMAD MONIR (PTA)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:MONIR
Last Name:HOSSAIN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9008 SUNRIDGE CIR APT 1226
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-4750
Mailing Address - Country:US
Mailing Address - Phone:203-360-5173
Mailing Address - Fax:
Practice Address - Street 1:1298 INTERSTATE PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6480
Practice Address - Country:US
Practice Address - Phone:706-868-1707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACPO38462A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant