Provider Demographics
NPI:1356530661
Name:FIBRAIO, SETH JASON (MPT, MTC, CSCS)
Entity type:Individual
Prefix:MR
First Name:SETH
Middle Name:JASON
Last Name:FIBRAIO
Suffix:
Gender:M
Credentials:MPT, MTC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 JULIAN LN
Mailing Address - Street 2:SUITE 660
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-7813
Mailing Address - Country:US
Mailing Address - Phone:828-684-3611
Mailing Address - Fax:828-684-3612
Practice Address - Street 1:600 JULIAN LN
Practice Address - Street 2:SUITE 660
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-7813
Practice Address - Country:US
Practice Address - Phone:828-684-3611
Practice Address - Fax:828-684-3612
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00944300225100000X, 2251X0800X
NC11519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2335735Medicare PIN
NJ071361Medicare PIN