Provider Demographics
NPI:1295933679
Name:HOENE, JAKE T
Entity type:Individual
Prefix:MR
First Name:JAKE
Middle Name:T
Last Name:HOENE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 OAK BOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-8328
Mailing Address - Country:US
Mailing Address - Phone:636-386-3623
Mailing Address - Fax:
Practice Address - Street 1:12509 VILLAGE CIRCLE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1701
Practice Address - Country:US
Practice Address - Phone:314-270-7790
Practice Address - Fax:314-849-2045
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117618225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant