Provider Demographics
NPI:1104073618
Name:ST MENA THERAPY P.C.
Entity type:Organization
Organization Name:ST MENA THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.T.
Authorized Official - Prefix:
Authorized Official - First Name:FADY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMALH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-308-9211
Mailing Address - Street 1:9150 DRAKE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9066
Mailing Address - Country:US
Mailing Address - Phone:219-308-9211
Mailing Address - Fax:219-558-2052
Practice Address - Street 1:9150 DRAKE DR
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9066
Practice Address - Country:US
Practice Address - Phone:219-308-9211
Practice Address - Fax:219-558-2052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070009472261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy