Provider Demographics
NPI:1386967248
Name:SEOUDI, MOHAMED (PT)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:SEOUDI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 BROADWAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1742
Mailing Address - Country:US
Mailing Address - Phone:845-796-2470
Mailing Address - Fax:845-796-1420
Practice Address - Street 1:427 BROADWAY
Practice Address - Street 2:SUITE 3
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1742
Practice Address - Country:US
Practice Address - Phone:845-796-2470
Practice Address - Fax:845-796-1420
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist