Healthcare Provider Details

I. General information

NPI: 1619060985
Provider Name (Legal Business Name): MOHY M OSMAN P.T
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17577 KEDZIE AVE STE 209
HAZEL CREST IL
60429-2053
US

IV. Provider business mailing address

8501 ROB ROY DR
ORLAND PARK IL
60462-5957
US

V. Phone/Fax

Practice location:
  • Phone: 708-781-9385
  • Fax: 708-570-2936
Mailing address:
  • Phone: 708-261-3803
  • Fax: 708-570-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-007373
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198.000441
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: