Provider Demographics
NPI:1932356441
Name:ELMALH, FADY (PT)
Entity Type:Individual
Prefix:
First Name:FADY
Middle Name:
Last Name:ELMALH
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 1:9150 DRAKE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9066
Mailing Address - Country:US
Mailing Address - Phone:219-308-9211
Mailing Address - Fax:219-558-2052
Practice Address - Street 1:9150 DRAKE DR
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9066
Practice Address - Country:US
Practice Address - Phone:219-308-9211
Practice Address - Fax:219-558-2052
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070009472225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist