Provider Demographics
NPI:1699958835
Name:ELSAYED, TAREK R (PT, DPT)
Entity type:Individual
Prefix:
First Name:TAREK
Middle Name:R
Last Name:ELSAYED
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17800 KEDZIE AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2029
Mailing Address - Country:US
Mailing Address - Phone:708-213-3825
Mailing Address - Fax:708-213-0132
Practice Address - Street 1:17800 KEDZIE AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2029
Practice Address - Country:US
Practice Address - Phone:708-213-3825
Practice Address - Fax:708-213-0132
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02975602Medicaid
NY02975602Medicaid