Carl Edward Jakowenko, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PA4170 Issued in ME

Practice address

378 Gorham Rd
Scarborough, ME 04074-9640

Phone

(207) 839-2373

NPI assigned

Sep 2, 2020

Sex

Male

Sole proprietor

Yes

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1599004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599004800000",
    "number": "1992319396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "378 GORHAM RD",
            "city": "SCARBOROUGH",
            "state": "ME",
            "postal_code": "040749640",
            "telephone_number": "207-839-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "378 GORHAM RD",
            "city": "SCARBOROUGH",
            "state": "ME",
            "postal_code": "040749640",
            "telephone_number": "207-839-2373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAKOWENKO",
        "first_name": "CARL",
        "middle_name": "EDWARD",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-09-02",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "ME",
            "license": "PA4170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaili Irvin
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• Melissa Lousie Jackson
• Shelley M Jacobs, LCSW
• Brianna Jalbert
• James F Flaherty DO LLC
• Sarae Alison Sager Jandreau, DO
• Erin Jaquith, OTR/L
• Ruby Louise Jarrett, PHARMD

• Physical Therapy Assistant in Scarborough, ME
• Providers in Scarborough, ME by specialty
• Physical Therapy Assistant in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; 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.