MEDICARE: HUSSIEN MOHAMED AHMED PHYSICAL THERAPIST

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	019278	NY

General Provider Information

NPI Number	:	1730200262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUSSIEN MOHAMED AHMED PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	312 MCCLEAN AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-4457
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9711 3RD AVE STE 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-7717
Country	:	US
Telephone Number	:	718-755-5367
Fax Number	:	888-908-8284

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	05/29/2019

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