Provider Demographics
NPI:1306290408
Name:ELAWADTHERAPY
Entity type:Organization
Organization Name:ELAWADTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GAMAL
Authorized Official - Middle Name:SALMAN
Authorized Official - Last Name:ELAWAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-468-8468
Mailing Address - Street 1:537 SANTA BARBARA DR
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-3453
Mailing Address - Country:US
Mailing Address - Phone:770-991-1227
Mailing Address - Fax:770-991-1226
Practice Address - Street 1:512 S HOUSTON LAKE RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6308
Practice Address - Country:US
Practice Address - Phone:770-468-8468
Practice Address - Fax:478-254-4026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-15
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
GAPTO11332261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy