Provider Demographics
NPI:1437414646
Name:IBRAHIM ALI, GOMAA RAMADAN (PT)
Entity Type:Individual
Prefix:
First Name:GOMAA
Middle Name:RAMADAN
Last Name:IBRAHIM ALI
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 1:611 MAY APPLE WAY
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-7278
Mailing Address - Country:US
Mailing Address - Phone:941-206-5200
Mailing Address - Fax:941-504-6842
Practice Address - Street 1:1121 JACARANDA BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-4586
Practice Address - Country:US
Practice Address - Phone:941-206-5200
Practice Address - Fax:941-504-6842
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist