Provider Demographics
NPI:1225076912
Name:INQUIMBOY, IAN (PT)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:INQUIMBOY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 SURRY CIRCLE SOUTH
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-7916
Mailing Address - Country:US
Mailing Address - Phone:910-255-6526
Mailing Address - Fax:910-255-6526
Practice Address - Street 1:65 SURRY CIRCLE SOUTH
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-7916
Practice Address - Country:US
Practice Address - Phone:910-255-6526
Practice Address - Fax:910-255-6526
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016788225100000X
NCP10707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2503417Medicare PIN
NYQH5981Medicare ID - Type UnspecifiedPHYSICAL THERAPY PRIVATE