Individual
BAHRAM THOMAS DIBADJ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2810 FRANK SCOTT PKWY W, STE. 824, BELLEVILLE, IL 62223-5007
(618) 234-9705
(618) 257-0665
Mailing address
2810 FRANK SCOTT PKWY W, STE. 824, BELLEVILLE, IL 62223-5007
(618) 234-9705
(618) 257-0665
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070006477
IL
Other
Enumeration date
03/14/2007
Last updated
03/25/2010
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