Provider Demographics
NPI:1366004699
Name:EL-MEGHALLAWY, MOHAMED ALY (PT)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ALY
Last Name:EL-MEGHALLAWY
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 1:7120 W 108TH ST UNIT 1B
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-1666
Mailing Address - Country:US
Mailing Address - Phone:708-369-7956
Mailing Address - Fax:
Practice Address - Street 1:6060 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2778
Practice Address - Country:US
Practice Address - Phone:708-952-1052
Practice Address - Fax:708-952-1053
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070024157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist