Active NPI
Yasser Mahmoud
- Physical Therapist
- Myrtle Beach, SC
National Provider Identifier
1174829154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2645
- Practice address
- 4730 Harvest Dr
Myrtle Beach, SC 29579-1742 - Phone
- (803) 477-5437
- NPI assigned
- Feb 8, 2011
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2645 | SC | Primary |
Addresses
Primary practice location
4730 Harvest Dr
Myrtle Beach, SC 29579-1742
Mailing address
4730 Harvest Dr
Myrtle Beach, SC 29579-1742
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 |
|---|---|---|---|
| 2645 | SC | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1297123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297123200000",
"number": "1174829154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4730 HARVEST DR",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295791742"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4730 HARVEST DR",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295791742",
"telephone_number": "803-477-5437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHMOUD",
"first_name": "YASSER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-02-08",
"last_updated": "2011-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "SC",
"license": "2645",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Myrtle Beach, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.