MEDICARE: YAZAN 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

General Provider Information

NPI Number	:	1902736739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAZAN MAHMOUD

Provider Business Mailing Address
First Line	:	400 E RYAN RD
Second Line	:
City	:	OAK CREEK
State	:	WI
Zip	:	53154-4554
Country	:	US
Telephone Number	:	414-394-1391
Fax Number	:

Provider Business Practice Location Address
First Line	:	3811 SPRING ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53405-1667
Country	:	US
Telephone Number	:	262-587-5300
Fax Number	:

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

Provider Enumeration Date	:	05/22/2026
Last Update Date	:	05/22/2026

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