Healthcare Provider Details

I. General information

NPI: 1912915455
Provider Name (Legal Business Name): JEFFREY ALAN LUBBERS P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 PEMBERTON HILL RD SUITE 202
APEX NC
27502-4265
US

IV. Provider business mailing address

3116 COMSTOCK RD
RALEIGH NC
27604-3507
US

V. Phone/Fax

Practice location:
  • Phone: 10-367-0866
  • Fax: 919-367-0866
Mailing address:
  • Phone: 919-872-6167
  • Fax: 919-872-6167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1119
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: