Provider Demographics
NPI:1184677262
Name:HUSSEIN, MOHAMED (PT)
Entity Type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:
Last Name:HUSSEIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2373
Mailing Address - Country:US
Mailing Address - Phone:850-522-4770
Mailing Address - Fax:850-522-4760
Practice Address - Street 1:2316 W 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2373
Practice Address - Country:US
Practice Address - Phone:850-522-4770
Practice Address - Fax:850-522-4760
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL202945722OtherTRICARE
FLQ6AOtherBCBS OF FL
FL5668714OtherAETNA
FL891217300Medicaid
FL202945722OtherTRICARE