Active NPI
Mohamed Ghoniem Ibrahim, PT
- Specialist
- Lady Lake, FL
National Provider Identifier
1043488216
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- PT 12757
- Practice address
- 607 Highway 466
Suite a
Lady Lake, FL 32159-3792 - Phone
- (352) 787-0669
- NPI assigned
- Feb 11, 2008
- Last updated
- Feb 11, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | PT 12757 | FL | Primary |
Addresses
Primary practice location
607 Highway 466
Suite a
Lady Lake, FL 32159-3792
Mailing address
607 Highway 466
Suite a
Lady Lake, FL 32159-3792
Phone (352) 787-0669
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT 12757 | Other | FL | PT LIC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 12757 | FL | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Abbey Rehabilitation Specialists of Lake County Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Village Rehabilitation Specialists of Lady Lake
- Physical Therapist
- Lady Lake, FL
- NPI 1457438236
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202688000000",
"number": "1043488216",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "607 HIGHWAY 466",
"address_2": "SUITE A",
"city": "LADY LAKE",
"state": "FL",
"postal_code": "321593792",
"telephone_number": "352-787-0669"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "607 HIGHWAY 466",
"address_2": "SUITE A",
"city": "LADY LAKE",
"state": "FL",
"postal_code": "321593792",
"telephone_number": "352-787-0669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBRAHIM",
"first_name": "MOHAMED",
"middle_name": "GHONIEM",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-11",
"last_updated": "2008-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "FL",
"license": "PT 12757",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PT LIC",
"identifier": "PT 12757",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lady Lake, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.