Provider Demographics
NPI:1073720470
Name:KHELLA, SAMEH L
Entity Type:Individual
Prefix:
First Name:SAMEH
Middle Name:L
Last Name:KHELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8325
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-8325
Mailing Address - Country:US
Mailing Address - Phone:847-722-8472
Mailing Address - Fax:847-397-6132
Practice Address - Street 1:2307 JOSEPHINE CT
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-7282
Practice Address - Country:US
Practice Address - Phone:847-722-8472
Practice Address - Fax:847-397-6132
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist