Provider Demographics
NPI:1740841089
Name:IMAM, IQRA CHHOTANI (PT, DPT, MS)
Entity type:Individual
Prefix:
First Name:IQRA
Middle Name:CHHOTANI
Last Name:IMAM
Suffix:
Gender:F
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 CANTERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-7806
Mailing Address - Country:US
Mailing Address - Phone:336-264-7369
Mailing Address - Fax:
Practice Address - Street 1:10820 PENNY RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-1916
Practice Address - Country:US
Practice Address - Phone:919-303-7068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP17753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist