MEDICARE: AZEEAM S KHALEEL PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251E1300X	Clinical Electrophysiology Physical Therapist	PT19430	FL

General Provider Information

NPI Number	:	1154436798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AZEEAM S KHALEEL PT

Provider Business Mailing Address
First Line	:	721 CALABRIA WAY
Second Line	:
City	:	HOWEY IN THE HILLS
State	:	FL
Zip	:	34737-0047
Country	:	US
Telephone Number	:	407-844-7036
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 CALABRIA WAY
Second Line	:
City	:	HOWEY IN THE HILLS
State	:	FL
Zip	:	34737-0047
Country	:	US
Telephone Number	:	407-844-7036
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	04/20/2022

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