MEDICARE: DR. MOHAMED ATTIA IBRAHIM PT, DSC, MS, NCS

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	017552	NY
2	2251N0400X	Neurology Physical Therapist	4951	IL
3	225100000X	Physical Therapist	070007653	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	731267	OTHER	IL	OPTUM HEALTH
2	7488668	OTHER		AETNA PPO
3	1628667	OTHER	IL	BCBS OF IL. PPO
4	2498142	OTHER		UNITED HEALTH CARE

General Provider Information

NPI Number	:	1639155807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMED ATTIA IBRAHIM PT, DSC, MS, NCS

Provider Business Mailing Address
First Line	:	PO BOX 488
Second Line	:
City	:	WORTH
State	:	IL
Zip	:	60482-0488
Country	:	US
Telephone Number	:	708-945-7171
Fax Number	:	708-919-1535

Provider Business Practice Location Address
First Line	:	1925 E 95TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-4710
Country	:	US
Telephone Number	:	312-929-2950
Fax Number	:	312-224-4777

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	03/05/2020

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