Provider Demographics
NPI:1033469143
Name:FOX, JACOB (ATC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:FOX
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8838 US HIGHWAY 70 W
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-4822
Mailing Address - Country:US
Mailing Address - Phone:919-553-5505
Mailing Address - Fax:
Practice Address - Street 1:8838 US HIGHWAY 70 W
Practice Address - Street 2:SUITE 700
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-4822
Practice Address - Country:US
Practice Address - Phone:919-553-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer