Basic Information
| Provider Information | |||||||||
| NPI: | 1003150939 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALEM | ||||||||
| FirstName: | MOHAMMAD | ||||||||
| MiddleName: | ALI | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6606 W 89TH PL | ||||||||
| Address2: | |||||||||
| City: | OAK LAWN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604531026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086068735 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8540 S HARLEM AVE | ||||||||
| Address2: | |||||||||
| City: | BRIDGEVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604551778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085982605 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2012 | ||||||||
| LastUpdateDate: | 11/15/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 160.006048 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.