Provider Demographics
NPI:1447596663
Name:ZAIDI, ILYAS H
Entity type:Individual
Prefix:MR
First Name:ILYAS
Middle Name:H
Last Name:ZAIDI
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ILYAS
Other - Middle Name:H
Other - Last Name:ZAIDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:18527 RELIANT DR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-5419
Mailing Address - Country:US
Mailing Address - Phone:301-526-3972
Mailing Address - Fax:
Practice Address - Street 1:18566 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-0587
Practice Address - Country:US
Practice Address - Phone:301-526-3972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-15
Last Update Date:2012-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20105261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy