Provider Demographics
NPI:1386817138
Name:EL REFAIE, HOSSAM A
Entity Type:Individual
Prefix:
First Name:HOSSAM
Middle Name:A
Last Name:EL REFAIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14440 F ST
Mailing Address - Street 2:STE 103
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1005
Mailing Address - Country:US
Mailing Address - Phone:402-630-9756
Mailing Address - Fax:402-504-3535
Practice Address - Street 1:11912 ELM ST
Practice Address - Street 2:SUITE 106
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4443
Practice Address - Country:US
Practice Address - Phone:402-630-9756
Practice Address - Fax:402-504-3535
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025105700Medicaid
NE10025105700Medicaid
NEP00334969Medicare Oscar/Certification