Provider Demographics
NPI:1972200798
Name:RAHHAL, AMIR MASHHOUR (PT)
Entity type:Individual
Prefix:
First Name:AMIR
Middle Name:MASHHOUR
Last Name:RAHHAL
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 1:6307 PRAIRIE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-8454
Mailing Address - Country:US
Mailing Address - Phone:817-682-7378
Mailing Address - Fax:
Practice Address - Street 1:1748 E BROAD ST STE 120
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9169
Practice Address - Country:US
Practice Address - Phone:817-477-4567
Practice Address - Fax:817-477-4591
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1373532225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist