Individual
JACOB RILEY PROFFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DAT
Contact information
Practice address
12400 BURBANK DR, BATON ROUGE, LA 70810
(225) 924-2157
Mailing address
142 LOBDELL AVE, BATON ROUGE, LA 70806-4610
(225) 924-2157
(225) 924-5674
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
337524
LA
2255A2300X
Athletic Trainer
36003343A
IN
2255A2300X
Athletic Trainer
AL6250
FL
Other
Enumeration date
01/08/2018
Last updated
09/26/2024
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