Provider Demographics
NPI:1497401053
Name:KHALIFA, KHALED M (PT)
Entity Type:Individual
Prefix:
First Name:KHALED
Middle Name:M
Last Name:KHALIFA
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 1:1169 PROGRESS RD
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-3275
Mailing Address - Country:US
Mailing Address - Phone:717-263-1640
Mailing Address - Fax:
Practice Address - Street 1:1169 PROGRESS RD
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-3275
Practice Address - Country:US
Practice Address - Phone:717-263-1640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009453L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist