Organization
SPORTS AND ORTHO P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAHLIA FAHMY PT (PRESIDENT/OWNER)
(312) 375-5354
Entity
Organization
Contact information
Practice address
412 W 31ST ST, CHICAGO, IL 60616-3116
(312) 225-3119
(312) 225-3219
Mailing address
412 W 31ST ST, CHICAGO, IL 60616-3116
(312) 225-3119
(312) 225-3219
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
—
—
2251S0007X
Sports Physical Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01633349
BLUE CROSS
IL
Enumeration date
01/04/2007
Last updated
12/24/2023
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