Provider Demographics
NPI:1306240866
Name:IN-HOME PHYSICAL THERAPY SERVICE LLC
Entity type:Organization
Organization Name:IN-HOME PHYSICAL THERAPY SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKALYOBI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MSPT, DPT
Authorized Official - Phone:203-930-0539
Mailing Address - Street 1:19 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5614
Mailing Address - Country:US
Mailing Address - Phone:203-930-0539
Mailing Address - Fax:
Practice Address - Street 1:19 2ND AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5614
Practice Address - Country:US
Practice Address - Phone:203-930-0539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty