Provider Demographics
NPI:1629622709
Name:HUGHES, JAKE ILIE (DAT, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:JAKE
Middle Name:ILIE
Last Name:HUGHES
Suffix:
Gender:M
Credentials:DAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 DENNISON AVE APT 215
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-2549
Mailing Address - Country:US
Mailing Address - Phone:253-777-5777
Mailing Address - Fax:
Practice Address - Street 1:1025 DENNISON AVE APT 215
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-2549
Practice Address - Country:US
Practice Address - Phone:253-777-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-28
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer