Basic Information
| Provider Information | |||||||||
| NPI: | 1417376658 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABED | ||||||||
| FirstName: | MOHAMMED | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10233 W ROOSEVELT RD | ||||||||
| Address2: | |||||||||
| City: | WESTCHESTER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601542518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089385238 | ||||||||
| FaxNumber: | 7089385239 | ||||||||
| Practice Location | |||||||||
| Address1: | 8755 S HARLEM AVE | ||||||||
| Address2: | |||||||||
| City: | BRIDGEVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604551905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084302295 | ||||||||
| FaxNumber: | 7084302372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2014 | ||||||||
| LastUpdateDate: | 04/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 160005974 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.