Individual
JACOB LEE PROCTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
421 VAN THOMAS DR, RALEIGH, NC 27615-5232
(919) 424-5080
Mailing address
1000 WILTON RD, NEW IBERIA, LA 70560-8534
(337) 967-9980
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11704
LA
Other
Enumeration date
11/30/2023
Last updated
11/30/2023
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