Jacob Lee Proctor, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

11704 Issued in LA

Practice address

421 Van Thomas Dr
Raleigh, NC 27615-5232

Phone

(919) 424-5080

NPI assigned

Nov 30, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• University of North Carolina Hospitals at Chapel Hill

  • Interventional Cardiology Physician
  • Chapel Hill, NC
  • NPI 1568070308
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701302400000",
    "number": "1679349740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 WILTON RD",
            "city": "NEW IBERIA",
            "state": "LA",
            "postal_code": "705608534",
            "telephone_number": "337-967-9980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 VAN THOMAS DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276155232",
            "telephone_number": "919-424-5080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "JACOB",
        "middle_name": "LEE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-11-30",
        "last_updated": "2023-11-30",
        "certification_date": "2023-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "11704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Proactive Physical Therapy & Performance LLC
• Proactive Therapy of North Carolina Inc
• Megan Jessica Probasco, FNP
• Daniel Prober
• Cheryl Proctor, F.N.P.
• Leah Ann Proctor, PHARMD
• Mary Rachels Proctor, CRNA
• Prodigy Health and Wellness PLLC
• Prodigy Healthcare Services Inc.
• Karyn Lena Proeschel

• Physical Therapist in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.