Provider Demographics
NPI:1275623571
Name:ABDELDAIEM, AHMED (PT)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:ABDELDAIEM
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 1:17901 GOVERNORS HWY STE 20
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1145
Mailing Address - Country:US
Mailing Address - Phone:773-374-7800
Mailing Address - Fax:
Practice Address - Street 1:17901 GOVERNORS HWY STE 20
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1145
Practice Address - Country:US
Practice Address - Phone:773-374-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
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