Healthcare Provider Details

I. General information

NPI: 1720914815
Provider Name (Legal Business Name): SEAN ROBERT ST. JACQUES DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 HIGH HOUSE RD STE 105
CARY NC
27513-3576
US

IV. Provider business mailing address

1010 HIGH HOUSE RD STE 105
CARY NC
27513-3576
US

V. Phone/Fax

Practice location:
  • Phone: 919-473-6020
  • Fax: 919-238-9982
Mailing address:
  • Phone: 919-473-6020
  • Fax: 919-238-9982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP25085
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: