Healthcare Provider Details

I. General information

NPI: 1629020706
Provider Name (Legal Business Name): KHALED M RASHAD P.T,DPT,OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6526 S PULASKI RD
CHICAGO IL
60629-5136
US

IV. Provider business mailing address

PO BOX 2009
ORLAND PARK IL
60462-1000
US

V. Phone/Fax

Practice location:
  • Phone: 773-585-9460
  • Fax: 773-585-7030
Mailing address:
  • Phone: 773-585-9460
  • Fax: 773-585-7030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-007340
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: