Provider Demographics
NPI:1417376658
Name:ABED, MOHAMMED (PTA)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:ABED
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10233 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-2518
Mailing Address - Country:US
Mailing Address - Phone:708-938-5238
Mailing Address - Fax:708-938-5239
Practice Address - Street 1:8755 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-1905
Practice Address - Country:US
Practice Address - Phone:708-430-2295
Practice Address - Fax:708-430-2372
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160005974225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant