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General NPI Number Information
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NPI Number | 1003344540
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Entity Type | Individual
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Provider Name | MOHAMED MANSOUR PHYSICAL THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 05/29/2017
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Last Update Date | 05/29/2017
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Provider Practice Location Address
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Address Line | 5 DAKOTA DR STE 200
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1109
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Country | US
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Telephone | 718-281-8521
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Fax |
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Provider Business Mailing Address
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Address Line | 19 BATTERY AVE
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City | BROOKLYN
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State | NY
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Zip | 11228-3501
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Country | US
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Telephone | 646-750-4949
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 028159
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License Number State | NY
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