Provider Demographics
NPI:1457674749
Name:KHALIL, AMMAR A (LPTA)
Entity Type:Individual
Prefix:MR
First Name:AMMAR
Middle Name:A
Last Name:KHALIL
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10737 S PRESERVE WAY
Mailing Address - Street 2:APT 208
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6557
Mailing Address - Country:US
Mailing Address - Phone:561-843-9799
Mailing Address - Fax:
Practice Address - Street 1:10737 S PRESERVE WAY APT 208
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-6557
Practice Address - Country:US
Practice Address - Phone:561-843-9799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA21160225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA21160OtherLPTA 21160