Provider Demographics
NPI:1942249305
Name:GOMAA, HALA M (LPT)
Entity Type:Individual
Prefix:
First Name:HALA
Middle Name:M
Last Name:GOMAA
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4647 W 103RD ST
Mailing Address - Street 2:STE. #2E
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4779
Mailing Address - Country:US
Mailing Address - Phone:708-425-9466
Mailing Address - Fax:708-425-3422
Practice Address - Street 1:4647 W 103RD ST
Practice Address - Street 2:STE. #2L
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4779
Practice Address - Country:US
Practice Address - Phone:708-425-9466
Practice Address - Fax:708-425-3422
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00228429OtherRAILROAD MEDICARE PIN
ILP00228429OtherRAILROAD MEDICARE PIN