Provider Demographics
NPI:1770152688
Name:SCIBOR, JASON J (MS, LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:J
Last Name:SCIBOR
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 SE CARY PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7413
Mailing Address - Country:US
Mailing Address - Phone:919-467-7801
Mailing Address - Fax:
Practice Address - Street 1:1120 SE CARY PKWY STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7413
Practice Address - Country:US
Practice Address - Phone:919-467-7801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0022207XX0005X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine