Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160.006048 | IL |
NPI | 1003150939 |
---|---|
Provider Name | Mr. Mohammad Ali Salem |
First Address | Oak Lawn, IL 60453-1026 |
Second Address | Bridgeview, IL 60455-1778 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 15/11/2012 |