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General NPI Number Information
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NPI Number | 1780295717
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Entity Type | Individual
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Provider Name | KHALEEL LEROY ABDUL-JABBAAR PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 08/13/2020
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 1493 CAMBRIDGE ST
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City | CAMBRIDGE
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State | MA
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Zip | 02139-1047
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Country | US
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Telephone | 617-665-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 27 TACOMA ST
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City | HYDE PARK
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State | MA
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Zip | 02136-3203
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Country | US
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Telephone | 857-204-6228
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 25136
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License Number State | MA
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