Provider Demographics
NPI:1013895796
Name:ETIWY, MOHAMED (DPT)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:ETIWY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8855 BAY PKWY APT 2E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6422
Mailing Address - Country:US
Mailing Address - Phone:917-421-0172
Mailing Address - Fax:
Practice Address - Street 1:1760 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-5545
Practice Address - Country:US
Practice Address - Phone:917-819-8098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014842-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist