Provider Demographics
NPI:1043748957
Name:QAYUMI, JIBRAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:JIBRAN
Middle Name:
Last Name:QAYUMI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MATTHEWS DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-4302
Mailing Address - Country:US
Mailing Address - Phone:919-578-4200
Mailing Address - Fax:919-578-9922
Practice Address - Street 1:204 MATTHEWS DRIVE
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540
Practice Address - Country:US
Practice Address - Phone:919-578-4200
Practice Address - Fax:919-578-9922
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP17194225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist