Provider Demographics
NPI:1346365228
Name:PROCTOR, RICKY LEE (EDD, LAT, ATC)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:LEE
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:EDD, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:833 MONTLIEU AVE
Mailing Address - Street 2:HIGH POINT UNIVERSITY
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4221
Mailing Address - Country:US
Mailing Address - Phone:336-841-9267
Mailing Address - Fax:336-888-6319
Practice Address - Street 1:833 MONTLIEU AVE
Practice Address - Street 2:HIGH POINT UNIVERSITY
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4221
Practice Address - Country:US
Practice Address - Phone:336-841-9267
Practice Address - Fax:336-888-6319
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer