Provider Demographics
NPI:1952477952
Name:PROCTOR, JAMES STEVEN (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:STEVEN
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 SCARLET OAK ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75964-7140
Mailing Address - Country:US
Mailing Address - Phone:936-559-0313
Mailing Address - Fax:
Practice Address - Street 1:721 SCARLET OAK ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75964-7140
Practice Address - Country:US
Practice Address - Phone:936-559-0313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1130748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist