Provider Demographics
NPI:1538358825
Name:BADAWY, MOHAMED S (PT)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:S
Last Name:BADAWY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-1756
Mailing Address - Country:US
Mailing Address - Phone:770-207-6624
Mailing Address - Fax:770-207-6631
Practice Address - Street 1:1219 W SPRING ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-1756
Practice Address - Country:US
Practice Address - Phone:770-207-6624
Practice Address - Fax:770-207-6631
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist