Provider Demographics
NPI:1619060985
Name:OSMAN, MOHY M (PT)
Entity Type:Individual
Prefix:MR
First Name:MOHY
Middle Name:M
Last Name:OSMAN
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 1:8501 ROB ROY DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-5957
Mailing Address - Country:US
Mailing Address - Phone:708-261-3803
Mailing Address - Fax:708-570-2936
Practice Address - Street 1:17577 KEDZIE AVE
Practice Address - Street 2:STE 209
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2053
Practice Address - Country:US
Practice Address - Phone:708-781-9385
Practice Address - Fax:708-570-2936
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-007373225100000X
IL198.000441171100000X
IL175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6702001Medicare PIN