Provider Demographics
NPI:1891967709
Name:MAHDI, MOHAMMED FAROUK (PT)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMED
Middle Name:FAROUK
Last Name:MAHDI
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 1:1717 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-4345
Mailing Address - Country:US
Mailing Address - Phone:714-635-2642
Mailing Address - Fax:714-635-8547
Practice Address - Street 1:2226 MEDICAL CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-2657
Practice Address - Country:US
Practice Address - Phone:951-657-6559
Practice Address - Fax:951-657-0661
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACZ939ZMedicare PIN
CACZ939YMedicare PIN