Healthcare Provider Details

I. General information

NPI: 1508158643
Provider Name (Legal Business Name): IBRAHIM MUSTAFA ALTUBASI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3053 NEW GERMANY ROAD
EBENSBURG PA
15931
US

IV. Provider business mailing address

4733 CENTRE AVE APT 1C
PITTSBURGH PA
15213-1722
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-1100
  • Fax: 814-472-1105
Mailing address:
  • Phone: 412-512-5327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT021167
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: