Provider Demographics
NPI:1265612501
Name:ABDELATY, ISLAM
Entity type:Individual
Prefix:
First Name:ISLAM
Middle Name:
Last Name:ABDELATY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 TENNYSON PKWY STE 303
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4170
Mailing Address - Country:US
Mailing Address - Phone:917-806-3958
Mailing Address - Fax:469-609-0583
Practice Address - Street 1:5060 TENNYSON PKWY STE 303
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4170
Practice Address - Country:US
Practice Address - Phone:917-806-3958
Practice Address - Fax:469-609-0583
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-04
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027020225100000X
TX1339245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist