Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | ||
N | 226300000X | Kinesiotherapist |
NPI | 1255951232 |
---|---|
Provider Name | Dr. Ibraham Dababneh |
First Address | Fountain Hills, AZ 85268-8519 |
Second Address | Fountain Hills, AZ 85268-8519 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2020 |
Last Update Date | 21/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NA | NA (01) |