Healthcare Provider Details

I. General information

NPI: 1700550027
Provider Name (Legal Business Name): AMEER M AL-SABBAGH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 159TH ST
OAK FOREST IL
60452-2904
US

IV. Provider business mailing address

8013 MANSFIELD AVE
BURBANK IL
60459-1949
US

V. Phone/Fax

Practice location:
  • Phone: 708-296-2209
  • Fax:
Mailing address:
  • Phone: 224-409-8438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160.009254
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: