Active NPI
Jake T Hoene
- Physical Therapy Assistant
- Saint Louis, MO
National Provider Identifier
1295933679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 117618
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| 117618 | MO | MD | Physical 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.