Provider Demographics
NPI:1134688294
Name:ELKOSSEI, ASHRAF ALI (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:ASHRAF
Middle Name:ALI
Last Name:ELKOSSEI
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:9215 S TRIPP AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-1938
Mailing Address - Country:US
Mailing Address - Phone:708-989-8989
Mailing Address - Fax:708-229-2563
Practice Address - Street 1:9215 S TRIPP AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-1938
Practice Address - Country:US
Practice Address - Phone:708-989-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700076952081S0010X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine