Provider Demographics
NPI:1386142875
Name:ENGLE, CALEB JORDAN
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:JORDAN
Last Name:ENGLE
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 1:417 QUAINT SWAN DALE DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-1890
Mailing Address - Country:US
Mailing Address - Phone:304-995-6687
Mailing Address - Fax:
Practice Address - Street 1:417 QUAINT SWAN DALE DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-1890
Practice Address - Country:US
Practice Address - Phone:304-995-6687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer