Basic Information
Provider Information
NPI: 1780243535
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALAIWI
FirstName: MOHAMMED
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 600 OAKMONT LN STE 600C
Address2:  
City: WESTMONT
State: IL
PostalCode: 605595548
CountryCode: US
TelephoneNumber: 6305756200
FaxNumber: 6309285080
Practice Location
Address1: 909 DAVIS ST STE 220
Address2:  
City: EVANSTON
State: IL
PostalCode: 602013664
CountryCode: US
TelephoneNumber: 8477337906
FaxNumber: 8477338405
Other Information
ProviderEnumerationDate: 06/06/2019
LastUpdateDate: 06/06/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X070024330ILY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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