Provider Demographics
NPI:1508944638
Name:EAST & WEST PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:EAST & WEST PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSIOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HOSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-REFAIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-504-3535
Mailing Address - Street 1:2919 S 120TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4310
Mailing Address - Country:US
Mailing Address - Phone:402-504-3535
Mailing Address - Fax:402-934-3866
Practice Address - Street 1:2919 S 120TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4310
Practice Address - Country:US
Practice Address - Phone:402-504-3535
Practice Address - Fax:402-934-3866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1261261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099327Medicare ID - Type Unspecified