Provider Demographics
NPI:1992285530
Name:SIBOLE, JOLYNN LYNELL (PT)
Entity type:Individual
Prefix:MISS
First Name:JOLYNN
Middle Name:LYNELL
Last Name:SIBOLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4505
Mailing Address - Country:US
Mailing Address - Phone:828-439-9744
Mailing Address - Fax:828-439-9744
Practice Address - Street 1:107 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4505
Practice Address - Country:US
Practice Address - Phone:828-439-9744
Practice Address - Fax:828-439-9744
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP9907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist