Jake Wietholder, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT028061 Issued in PA

Practice address

625 Lincoln Ave Ste 107
North Charleroi, PA 15022-2451

Phone

(724) 483-4886

Fax

(724) 483-0519

NPI assigned

Oct 18, 2019

Last updated

Aug 14, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Orthopedic and Sports Physical Therapy Associates

  • Occupational Therapist
  • Connellsville, PA
  • NPI 1376947143
  NPD (past)
• Orthopedic and Sports Physical Therapy Assoc Inc

  • Occupational Therapist
  • Morgantown, WV
  • NPI 1558791020
  NPD (past)

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

{
    "created_epoch": "1571356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1326681743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 LINCOLN AVE STE 209",
            "city": "CHARLEROI",
            "state": "PA",
            "postal_code": "150222451",
            "telephone_number": "724-483-3610",
            "fax_number": "724-489-4758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 LINCOLN AVE STE 107",
            "city": "NORTH CHARLEROI",
            "state": "PA",
            "postal_code": "150222451",
            "telephone_number": "724-483-4886",
            "fax_number": "724-483-0519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIETHOLDER",
        "first_name": "JAKE",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-18",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT028061",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clayton C. Chacko, R.PH.
• Danielle Rose Cozza, O.D.
• Dennis F. Tolner DMD P.C.
• Lawrence D. Hamilton Jr., D.C.
• Kenneth Howard Lentz, MD

• Physical Therapist in North Charleroi, PA
• Providers in North Charleroi, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; 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.