Provider Demographics
NPI:1750546644
Name:ELGENDI, WILLIAM MAHROUS (RPT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MAHROUS
Last Name:ELGENDI
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11628 VENTURA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9458
Mailing Address - Country:US
Mailing Address - Phone:219-365-4561
Mailing Address - Fax:
Practice Address - Street 1:11628 VENTURA DR
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9458
Practice Address - Country:US
Practice Address - Phone:219-365-4561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004004A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist