MEDICARE: MR. ZAGHLOUL AHMED PT, PHD

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	015683-1	NY

General Provider Information

NPI Number	:	1538357082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ZAGHLOUL AHMED PT, PHD

Provider Business Mailing Address
First Line	:	431 BAY RIDGE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-2701
Country	:	US
Telephone Number	:	718-680-5679
Fax Number	:	718-680-5640

Provider Business Practice Location Address
First Line	:	431 BAY RIDGE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-2701
Country	:	US
Telephone Number	:	718-680-5679
Fax Number	:	718-680-5679

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

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	10/10/2007

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