Provider Demographics
NPI:1528403714
Name:HEALTH REACH PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:HEALTH REACH PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAZOZA
Authorized Official - Middle Name:MORSI
Authorized Official - Last Name:ABDALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:219-513-8866
Mailing Address - Street 1:9200 CALUMET AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2885
Mailing Address - Country:US
Mailing Address - Phone:219-513-8866
Mailing Address - Fax:219-513-8835
Practice Address - Street 1:9200 CALUMET AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2885
Practice Address - Country:US
Practice Address - Phone:219-513-8866
Practice Address - Fax:219-513-8835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004041A261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy