Provider Demographics
NPI:1457820839
Name:EL-REFAIE, LYLA HOSSAM
Entity Type:Individual
Prefix:
First Name:LYLA
Middle Name:HOSSAM
Last Name:EL-REFAIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 N OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-1726
Mailing Address - Country:US
Mailing Address - Phone:402-215-7323
Mailing Address - Fax:
Practice Address - Street 1:600 BROOKSTONE MEADOWS PLZ
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-4401
Practice Address - Country:US
Practice Address - Phone:402-289-2696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1651225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant