MEDICARE: YASSER MAHMOUD

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	225100000X	Physical Therapist	2645	SC

General Provider Information

NPI Number	:	1174829154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASSER MAHMOUD

Provider Business Mailing Address
First Line	:	4730 HARVEST DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-1742
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4730 HARVEST DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-1742
Country	:	US
Telephone Number	:	803-477-5437
Fax Number	:

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

Provider Enumeration Date	:	02/08/2011
Last Update Date	:	02/08/2011

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Directions to “ YASSER MAHMOUD ” Practice Location

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