Provider Demographics
NPI:1629020706
Name:RASHAD, KHALED M (PT,DPT,OCS)
Entity Type:Individual
Prefix:MR
First Name:KHALED
Middle Name:M
Last Name:RASHAD
Suffix:
Gender:M
Credentials:PT,DPT,OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2009
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1000
Mailing Address - Country:US
Mailing Address - Phone:773-585-9460
Mailing Address - Fax:773-585-7030
Practice Address - Street 1:6526 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5136
Practice Address - Country:US
Practice Address - Phone:773-585-9460
Practice Address - Fax:773-585-7030
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-007340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid
IL$$$$$$$$$001Medicaid
ILK24594Medicare UPIN