Provider Demographics
NPI:1871180448
Name:MAHMOUD, MENATALLA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MENATALLA
Middle Name:
Last Name:MAHMOUD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1614
Mailing Address - Country:US
Mailing Address - Phone:347-345-8370
Mailing Address - Fax:
Practice Address - Street 1:87 FORT GREENE PL STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1203
Practice Address - Country:US
Practice Address - Phone:718-522-2658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046617-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist