Provider Demographics
NPI:1316905490
Name:BADRA, LYDIA M (MSPT)
Entity type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:M
Last Name:BADRA
Suffix:
Gender:F
Credentials:MSPT
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Mailing Address - Street 1:15245 SHADY GROVE RD
Mailing Address - Street 2:SUITE C-100, NORTH LOBBY
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3222
Mailing Address - Country:US
Mailing Address - Phone:301-417-2652
Mailing Address - Fax:301-417-2653
Practice Address - Street 1:15245 SHADY GROVE RD
Practice Address - Street 2:SUITE C-100, NORTH LOBBY
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3222
Practice Address - Country:US
Practice Address - Phone:301-417-2652
Practice Address - Fax:301-417-2653
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DC870157225100000X
MD19658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC020509S57Medicare PIN