Provider Demographics
NPI:1710011945
Name:LEXINGTON PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:LEXINGTON PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:TAHA
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-257-3831
Mailing Address - Street 1:PO BOX 1354
Mailing Address - Street 2:
Mailing Address - City:BEDFORD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60499-1354
Mailing Address - Country:US
Mailing Address - Phone:708-257-3831
Mailing Address - Fax:708-599-1345
Practice Address - Street 1:13810 CICERO AVE
Practice Address - Street 2:SUITE F
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60445-1827
Practice Address - Country:US
Practice Address - Phone:708-257-3831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007027208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01639080OtherBLUE CROSS
IL215355Medicare PIN