=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720797228
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FWD REHAB & RECOVERY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2022
-----------------------------------------------------
Last Update Date | 11/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 462 N TERRY AVE APT 329
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32801-2034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-920-0792
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 462 N TERRY AVE APT 329
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32801-2034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-920-0792
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/HEAD PHYSICAL THERAPIST
-----------------------------------------------------
Name | DR. ALI JORDAN MOHAMAD
-----------------------------------------------------
Credential | DR.
-----------------------------------------------------
Telephone | 407-920-0892
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------