MEDICARE: MR. EHAB M ABDELMALEK

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	PT16803	FL

General Provider Information

NPI Number	:	1558420810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EHAB M ABDELMALEK

Provider Business Mailing Address
First Line	:	4558 SAN JUAN AVE
Second Line	:	SUITE B
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-2051
Country	:	US
Telephone Number	:	904-389-2077
Fax Number	:	904-389-1170

Provider Business Practice Location Address
First Line	:	4558 SAN JUAN AVE
Second Line	:	SUITE B
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-2051
Country	:	US
Telephone Number	:	904-389-2077
Fax Number	:	904-389-1170

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/08/2007

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