Provider Demographics
NPI:1568972438
Name:AIT ALLA, SAID (MMP)
Entity Type:Individual
Prefix:
First Name:SAID
Middle Name:
Last Name:AIT ALLA
Suffix:
Gender:M
Credentials:MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 BALTIMORE PIKE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342
Mailing Address - Country:US
Mailing Address - Phone:302-494-6377
Mailing Address - Fax:610-361-4474
Practice Address - Street 1:1102 BALTIMORE PIKE STE 111
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1058
Practice Address - Country:US
Practice Address - Phone:302-494-6377
Practice Address - Fax:610-361-4474
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG004887225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist