=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356326128
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEDHAT MOHAMMED ABDELRAHIM PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2005
-----------------------------------------------------
Last Update Date | 07/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12215 TELEGRAPH RD # 110
-----------------------------------------------------
City | SANTA FE SPRINGS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90670-3344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-777-1333
-----------------------------------------------------
Fax | 562-777-1347
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30112 CROWN VALLEY PKWY
-----------------------------------------------------
City | LAGUNA NIGUEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92677-2042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-363-7716
-----------------------------------------------------
Fax | 949-363-1244
-----------------------------------------------------
=====================================================
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 | PT 12917
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------