MEDICARE: MEDHAT MOHAMMED ABDELRAHIM PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT 12917	CA

General Provider Information

NPI Number	:	1356326128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEDHAT MOHAMMED ABDELRAHIM PT

Provider Business Mailing Address
First Line	:	30112 CROWN VALLEY PKWY
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-2042
Country	:	US
Telephone Number	:	949-363-7716
Fax Number	:	949-363-1244

Provider Business Practice Location Address
First Line	:	12215 TELEGRAPH RD
Second Line	:	# 110
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-3344
Country	:	US
Telephone Number	:	562-777-1333
Fax Number	:	562-777-1347

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	07/15/2025

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