Provider Demographics
NPI:1326437013
Name:ELKALYOBI, MAHMOUD (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:
Last Name:ELKALYOBI
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5614
Mailing Address - Country:US
Mailing Address - Phone:203-930-0539
Mailing Address - Fax:
Practice Address - Street 1:19 2ND AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5614
Practice Address - Country:US
Practice Address - Phone:203-930-0539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-18
Last Update Date:2015-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0054912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic