Provider Demographics
NPI:1871640565
Name:SPORTS AND ORTHO P.C
Entity type:Organization
Organization Name:SPORTS AND ORTHO P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAHLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAHMY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:312-375-5354
Mailing Address - Street 1:412 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3116
Mailing Address - Country:US
Mailing Address - Phone:312-225-3119
Mailing Address - Fax:312-225-3219
Practice Address - Street 1:412 W 31ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3116
Practice Address - Country:US
Practice Address - Phone:312-225-3119
Practice Address - Fax:312-225-3219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2023-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633349OtherBLUE CROSS
IL207630Medicare UPIN