Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | ||
N | 225100000X | Physical Therapist | 1345001 | TX |
N | 2251G0304X | Physical Therapist - Geriatrics | ||
N | 2251H1300X | Human Factors | ||
N | 225XH1300X | Human Factors | ||
N | 2251P0200X | Physical Therapist - Pediatrics | 036856 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1174068720 |
---|---|
Provider Name | Mohamed Khallaf |
First Address | Cedar Park, TX 78613-7182 |
Second Address | Ridgewood, NY 11385-5200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2017 |
Last Update Date | 06/07/2021 |