Provider Demographics
NPI:1508158643
Name:ALTUBASI, IBRAHIM MUSTAFA (PT)
Entity Type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:MUSTAFA
Last Name:ALTUBASI
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 1:4733 CENTRE AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1722
Mailing Address - Country:US
Mailing Address - Phone:412-512-5327
Mailing Address - Fax:
Practice Address - Street 1:3053 NEW GERMANY ROAD
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931
Practice Address - Country:US
Practice Address - Phone:814-472-1100
Practice Address - Fax:814-472-1105
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist