=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033899158
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAFAT HAMDAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2023
-----------------------------------------------------
Last Update Date | 07/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2627 NE 203RD ST STE 110
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-1945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-466-1388
-----------------------------------------------------
Fax | 305-466-9200
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 540 WEST AVE APT 1111
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33139-6770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-403-8835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT40035
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------