Provider Demographics
NPI:1790437937
Name:OWIEDA, MOHAMED (PT)
Entity Type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:
Last Name:OWIEDA
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 1:1764 E 19TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:347-465-5675
Mailing Address - Fax:855-955-3899
Practice Address - Street 1:138 5TH AVENUE, FLOOR 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:212-287-4257
Practice Address - Fax:855-955-3899
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047302-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist