Individual
JACOB DEESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, ATC
Contact information
Practice address
13333 DORMAN RD, PINEVILLE, NC 28134-9336
(704) 716-1024
Mailing address
6527 OLIVE BRANCH RD, MARSHVILLE, NC 28103-9606
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
P20196
NC
2255A2300X
Athletic Trainer
LAT-2888
NC
Other
Enumeration date
04/19/2017
Last updated
02/09/2021
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