Individual provider Active NPI

Jake T Hoene

  • Physical Therapy Assistant
  • Saint Louis, MO
National Provider Identifier
1295933679
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
117618 Issued in MO
Practice address
12509 Village Circle Dr
Saint Louis, MO 63127-1701
Phone
(314) 270-7790
Fax
(314) 849-2045
NPI assigned
Jul 6, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 117618 MO Primary

Addresses

Primary practice location

12509 Village Circle Dr
Saint Louis, MO 63127-1701

Mailing address

1136 Oak Borough Dr
Ballwin, MO 63021-8328
Phone (636) 386-3623

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
117618MOMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1183680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295933679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1136 OAK BOROUGH DR",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630218328",
            "telephone_number": "636-386-3623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12509 VILLAGE CIRCLE DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631271701",
            "telephone_number": "314-270-7790",
            "fax_number": "314-849-2045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOENE",
        "first_name": "JAKE",
        "middle_name": "T",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "117618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.