Provider Demographics
NPI:1386091171
Name:JABOLA, JOSUE PRADO III (PT)
Entity type:Individual
Prefix:MR
First Name:JOSUE
Middle Name:PRADO
Last Name:JABOLA
Suffix:III
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 1:1723 CHARITY LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4735
Mailing Address - Country:US
Mailing Address - Phone:910-670-6864
Mailing Address - Fax:
Practice Address - Street 1:1723 CHARITY LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4735
Practice Address - Country:US
Practice Address - Phone:910-670-6864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-21
Last Update Date:2016-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14585225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist