Provider Demographics
NPI:1558420810
Name:ABDELMALEK, EHAB M
Entity Type:Individual
Prefix:MR
First Name:EHAB
Middle Name:M
Last Name:ABDELMALEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4558 SAN JUAN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-2051
Mailing Address - Country:US
Mailing Address - Phone:904-389-2077
Mailing Address - Fax:904-389-1170
Practice Address - Street 1:4558 SAN JUAN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2051
Practice Address - Country:US
Practice Address - Phone:904-389-2077
Practice Address - Fax:904-389-1170
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist