Provider Demographics
NPI:1932413424
Name:EBRAHIM, WALEED YEHYA SR (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:WALEED
Middle Name:YEHYA
Last Name:EBRAHIM
Suffix:SR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:331 BAY 14TH STREET
Mailing Address - Street 2:FL #1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214
Mailing Address - Country:US
Mailing Address - Phone:917-686-6437
Mailing Address - Fax:718-872-7298
Practice Address - Street 1:242 RHINE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4504
Practice Address - Country:US
Practice Address - Phone:718-727-7436
Practice Address - Fax:718-727-7437
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018281-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist