Basic Information
| Provider Information | |||||||||
| NPI: | 1023377603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIKSERESHT | ||||||||
| FirstName: | ZAHRA | ||||||||
| MiddleName: | SUSAN | ||||||||
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| Credential: | MASTERS DEGREE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6000 EXECUTIVE BLV # 510 | ||||||||
| Address2: | NOT APPLICABLE | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017707900 | ||||||||
| FaxNumber: | 3017707904 | ||||||||
| Practice Location | |||||||||
| Address1: | 6000 EXECUTIVE BLVD STE 510 | ||||||||
| Address2: | NOT APPLICABLE | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208523830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017707900 | ||||||||
| FaxNumber: | 3017707904 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2012 | ||||||||
| LastUpdateDate: | 05/16/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 17581 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.