Provider Demographics
NPI:1700990645
Name:MOTAWEA, MOHAMMED H (PT)
Entity type:Individual
Prefix:MR
First Name:MOHAMMED
Middle Name:H
Last Name:MOTAWEA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:MOHAMMED
Other - Middle Name:HASSANAIN
Other - Last Name:MOTAWEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8455 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6220
Practice Address - Country:US
Practice Address - Phone:219-769-7211
Practice Address - Fax:219-769-7236
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004444A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist