Provider Demographics
NPI:1356786545
Name:ABDALLAH, MAZOZA MORSI (PT)
Entity type:Individual
Prefix:
First Name:MAZOZA
Middle Name:MORSI
Last Name:ABDALLAH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15826 ROB ROY DR
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-2742
Mailing Address - Country:US
Mailing Address - Phone:708-612-5207
Mailing Address - Fax:708-357-7236
Practice Address - Street 1:9200 CALUMET AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2885
Practice Address - Country:US
Practice Address - Phone:219-513-8866
Practice Address - Fax:219-513-8835
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004041A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist