Basic Information
| Provider Information | |||||||||
| NPI: | 1912303942 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CETINER | ||||||||
| FirstName: | AYHAN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 FAIRMOUNT AVE STE 302 | ||||||||
| Address2: | |||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212865494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015403529 | ||||||||
| FaxNumber: | 3015403623 | ||||||||
| Practice Location | |||||||||
| Address1: | 19785 CRYSTAL ROCK DR | ||||||||
| Address2: | SUITE 311 | ||||||||
| City: | GERMANTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208744700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015403529 | ||||||||
| FaxNumber: | 3015403623 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2014 | ||||||||
| LastUpdateDate: | 02/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 25274 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 25274 | 01 | MD | LICENSE NUMBER | OTHER |