Provider Demographics
NPI:1467499855
Name:EKLE, JADE WALTER (DPT)
Entity type:Individual
Prefix:DR
First Name:JADE
Middle Name:WALTER
Last Name:EKLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 N JESSICA BROOKE CIR STE C
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7333
Mailing Address - Country:US
Mailing Address - Phone:907-250-7295
Mailing Address - Fax:907-631-3032
Practice Address - Street 1:645 N JESSICA BROOKE CIR STE C
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7333
Practice Address - Country:US
Practice Address - Phone:907-631-0600
Practice Address - Fax:907-631-3032
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist