Provider Demographics
NPI:1164895603
Name:MOHAMED, MAHROUS (DPT)
Entity Type:Individual
Prefix:DR
First Name:MAHROUS
Middle Name:
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HARMONY LN
Mailing Address - Street 2:UNIT 54
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-7459
Mailing Address - Country:US
Mailing Address - Phone:845-321-4971
Mailing Address - Fax:
Practice Address - Street 1:50 HARMONY LN
Practice Address - Street 2:UNIT 54
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-7459
Practice Address - Country:US
Practice Address - Phone:845-321-4971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034575225100000X
VA2305208362225100000X
DCPT871974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist