Active NPI
Mark Jaeckle, PT
- Physical Therapist
- Orchard Park, NY
National Provider Identifier
1932978764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 010785-01
- Practice address
- 145 Stoughton LN
Orchard Park, NY 14127-2086 - Phone
- (716) 481-9044
- NPI assigned
- Dec 20, 2023
- 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 Therapist | 225100000X | 010785-01 | NY | Primary |
Addresses
Primary practice location
145 Stoughton LN
Orchard Park, NY 14127-2086
Mailing address
145 Stoughton LN
Orchard Park, NY 14127-2086
Phone (716) 481-9044
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010785 | NY | MD | Registered Dietitian |
| 010785-01 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1703030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703030400000",
"number": "1932978764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "145 STOUGHTON LN",
"city": "ORCHARD PARK",
"state": "NY",
"postal_code": "141272086",
"telephone_number": "716-481-9044"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "145 STOUGHTON LN",
"city": "ORCHARD PARK",
"state": "NY",
"postal_code": "141272086",
"telephone_number": "716-481-9044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAECKLE",
"first_name": "MARK",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-12-20",
"last_updated": "2023-12-20",
"certification_date": "2023-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "010785-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orchard Park, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 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.