Provider Demographics
NPI:1669594131
Name:ALI, MAHMOUD ALI (PT)
Entity type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:ALI
Last Name:ALI
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 1:195 MALLORY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3505
Mailing Address - Country:US
Mailing Address - Phone:917-714-0552
Mailing Address - Fax:718-447-8931
Practice Address - Street 1:195 MALLORY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3505
Practice Address - Country:US
Practice Address - Phone:917-714-0552
Practice Address - Fax:718-447-8931
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022872-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist