Provider Demographics
NPI:1134215502
Name:ISMAIL, OMRAN ABDELAZIZ (PT)
Entity type:Individual
Prefix:
First Name:OMRAN
Middle Name:ABDELAZIZ
Last Name:ISMAIL
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 1:9225 THOMAS AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-2143
Mailing Address - Country:US
Mailing Address - Phone:708-228-2540
Mailing Address - Fax:708-237-0997
Practice Address - Street 1:9225 THOMAS AVE FL 1
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-2143
Practice Address - Country:US
Practice Address - Phone:708-228-2540
Practice Address - Fax:708-237-0997
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist