Healthcare Provider Details

I. General information

NPI: 1568121788
Provider Name (Legal Business Name): MANAL MAHDY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 01/07/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 CHESTNUT ST
VALLEY STREAM NY
11580-2157
US

IV. Provider business mailing address

1045 CHESTNUT ST
VALLEY STREAM NY
11580-2157
US

V. Phone/Fax

Practice location:
  • Phone: 347-458-8720
  • Fax:
Mailing address:
  • Phone: 347-458-8720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number048291
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number048291
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: