Provider Demographics
NPI:1922511096
Name:IBRAHIM, AHMED MOURSI (PT)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:MOURSI
Last Name:IBRAHIM
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 1:8535 58TH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4811
Mailing Address - Country:US
Mailing Address - Phone:347-619-4720
Mailing Address - Fax:
Practice Address - Street 1:8535 58TH AVE APT 1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11373-4811
Practice Address - Country:US
Practice Address - Phone:347-619-4720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty