Individual
MR. JACOB TYLER DEPEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, ATC, LAT, PES
Contact information
Practice address
833 MONTLIEU AVE, HIGH POINT, NC 27262-4221
(336) 841-4500
(336) 841-9182
Mailing address
833 MONTLIEU AVE, HIGH POINT, NC 27262-4221
(336) 841-4500
(336) 841-9182
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1828
NC
Other
Enumeration date
05/18/2011
Last updated
05/18/2011
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