Provider Demographics
NPI:1487197737
Name:ABDELNAEEM, KHALED TAHA
Entity Type:Individual
Prefix:
First Name:KHALED
Middle Name:TAHA
Last Name:ABDELNAEEM
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 1:5 SUNSET WAY
Mailing Address - Street 2:
Mailing Address - City:THORHOLD
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L2V0B6
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 SUNSET WAY
Practice Address - Street 2:
Practice Address - City:THORHOLD
Practice Address - State:ONTARIO
Practice Address - Zip Code:L2V0B6
Practice Address - Country:CA
Practice Address - Phone:905-680-2981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist