Provider Demographics
NPI:1538309083
Name:ABDELFATAH, AHMED (PT)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:ABDELFATAH
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 1:9310 PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2339
Mailing Address - Country:US
Mailing Address - Phone:708-907-3245
Mailing Address - Fax:
Practice Address - Street 1:9310 PARKSIDE AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2339
Practice Address - Country:US
Practice Address - Phone:708-907-3245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2012-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023521225100000X
IL070019138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist