| Organization Name: | ST MENA THERAPY P.C. |
| NPI Number: | 1104073618 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FADY ELMALH (P.T.) |
| Mailing Address: | 9150 Drake Dr Saint John |
| State: | IN US |
| Postal Code: | 463739066 |
| Phone Number: | 2193089211 |
| Fax Number: | 2195582052 |
| NPI Enumeration Date: | 08/26/2008 |
| NPI Last Update Date: | 08/26/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 070009472 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |