Provider Demographics
NPI:1407248263
Name:ALY, AHMED ALY SAYED
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:ALY SAYED
Last Name:ALY
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 1:1455 OX BRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5403
Mailing Address - Country:US
Mailing Address - Phone:860-574-2163
Mailing Address - Fax:
Practice Address - Street 1:1165 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-8741
Practice Address - Country:US
Practice Address - Phone:678-761-1280
Practice Address - Fax:678-550-9728
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012383225100000X
NY037492-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist