Provider Demographics
NPI:1982833612
Name:IBRAHIM, MOHAMED SAEED (PT)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:SAEED
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 1:9800 VALPARAISO DR
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-4040
Mailing Address - Country:US
Mailing Address - Phone:219-934-9847
Mailing Address - Fax:241-993-4984
Practice Address - Street 1:9800 VALPARAISO DR
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4040
Practice Address - Country:US
Practice Address - Phone:219-934-9847
Practice Address - Fax:241-993-4984
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003890A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist