Organization
LEXINGTON PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AHMED TAHA MOHAMMED (PRESIDENT)
(708) 257-3831
Entity
Organization
Contact information
Practice address
13810 CICERO AVE, SUITE F, CRESTWOOD, IL 60445-1827
(708) 257-3831
Mailing address
PO BOX 1354, BEDFORD PARK, IL 60499-1354
(708) 257-3831
(708) 599-1345
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
070007027
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01639080
BLUE CROSS
IL
Enumeration date
03/16/2007
Last updated
09/20/2011
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