Provider Demographics
NPI:1568292134
Name:MOHAMED HASSAN, AHMED ALAAELDIN (PTA)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:ALAAELDIN
Last Name:MOHAMED HASSAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6857 PULASKI AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:VA
Mailing Address - Zip Code:24141-8817
Mailing Address - Country:US
Mailing Address - Phone:540-998-9926
Mailing Address - Fax:
Practice Address - Street 1:6857 PULASKI AVE
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:VA
Practice Address - Zip Code:24141-8817
Practice Address - Country:US
Practice Address - Phone:540-998-9926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306605116225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant