Healthcare Provider Details

I. General information

NPI: 1902072705
Provider Name (Legal Business Name): HESHAM HEGAZY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 DOWNING PL
ENGLEWOOD OH
45322-1125
US

IV. Provider business mailing address

282 DOWNING PL
ENGLEWOOD OH
45322-1125
US

V. Phone/Fax

Practice location:
  • Phone: 937-510-8658
  • Fax:
Mailing address:
  • Phone: 937-510-8658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05004415A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: