Active NPI
Jake Engle
- Physical Therapist
- Kingwood, WV
National Provider Identifier
1346962255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 004175
- Practice address
- 419 Morgantown St
Kingwood, WV 26537-1095 - Phone
- (304) 329-3565
- NPI assigned
- Sep 16, 2022
- Sex
- Male
- Sole proprietor
- No
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 Therapist | 225100000X | 004175 | WV | Primary |
Addresses
Primary practice location
419 Morgantown St
Kingwood, WV 26537-1095
Mailing address
1013 Saint Pauls LN
Morgantown, WV 26505-1503
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 |
|---|---|---|---|
| 004175 | WV | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Preston Memorial Homecare, LLC | Current | Accepting new patients |
Locations
419 Morgantown St
Kingwood, WV 26537
Phone (304) 329-3565
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Home Health Agency
- Kingwood, WV
- NPI 1659600310
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663286400000",
"number": "1346962255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1013 SAINT PAULS LN",
"city": "MORGANTOWN",
"state": "WV",
"postal_code": "265051503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "419 MORGANTOWN ST",
"city": "KINGWOOD",
"state": "WV",
"postal_code": "265371095",
"telephone_number": "304-329-3565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENGLE",
"first_name": "JAKE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-16",
"last_updated": "2022-09-16",
"certification_date": "2022-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WV",
"license": "004175",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingwood, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.