Provider Demographics
NPI:1245667310
Name:ALKHYYAT, AHMAD M (LAC)
Entity type:Individual
Prefix:MR
First Name:AHMAD
Middle Name:M
Last Name:ALKHYYAT
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12213 BRIGHTWATER BLVD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1708
Mailing Address - Country:US
Mailing Address - Phone:813-994-0266
Mailing Address - Fax:
Practice Address - Street 1:12213 BRIGHTWATER BLVD
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-1708
Practice Address - Country:US
Practice Address - Phone:813-994-0266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3222171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist