Provider Demographics
NPI:1861523060
Name:HUGHES, THOMAS 'JAKE' EDWARD (PT)
Entity type:Individual
Prefix:MR
First Name:THOMAS 'JAKE'
Middle Name:EDWARD
Last Name:HUGHES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9528 MIRAMAR RD
Mailing Address - Street 2:# 24
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4533
Mailing Address - Country:US
Mailing Address - Phone:858-549-2898
Mailing Address - Fax:858-549-2141
Practice Address - Street 1:9528 MIRAMAR RD
Practice Address - Street 2:# 24
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4533
Practice Address - Country:US
Practice Address - Phone:858-549-2898
Practice Address - Fax:858-549-2141
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 7172225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 7172OtherSTATE LICENSE