Provider Demographics
NPI:1104973841
Name:FAHMY, DAHLIA (PT)
Entity type:Individual
Prefix:
First Name:DAHLIA
Middle Name:
Last Name:FAHMY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3116
Mailing Address - Country:US
Mailing Address - Phone:312-375-5354
Mailing Address - Fax:312-225-3219
Practice Address - Street 1:412 W 31ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3116
Practice Address - Country:US
Practice Address - Phone:312-225-3119
Practice Address - Fax:312-225-3219
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK02191Medicare ID - Type Unspecified