Provider Demographics
NPI:1679189823
Name:HUGHES, JACOB ALEXANDER (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ALEXANDER
Last Name:HUGHES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 HEWITT AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3600
Mailing Address - Country:US
Mailing Address - Phone:425-252-3908
Mailing Address - Fax:425-252-7940
Practice Address - Street 1:2000 HEWITT AVE STE 115
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3600
Practice Address - Country:US
Practice Address - Phone:425-252-3908
Practice Address - Fax:425-252-7940
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31452225100000X
WA61135032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist