Provider Demographics
NPI:1588969398
Name:SAMRAH, DINA ANNSAR (DPT)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:ANNSAR
Last Name:SAMRAH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:ANNSAR
Other - Last Name:HAMAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7814 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3536
Mailing Address - Country:US
Mailing Address - Phone:708-456-2322
Mailing Address - Fax:708-456-2395
Practice Address - Street 1:7814 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-3536
Practice Address - Country:US
Practice Address - Phone:708-456-2322
Practice Address - Fax:708-456-2395
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist