Provider Demographics
NPI:1578328860
Name:PURKINS, JAKE E (DPT)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:E
Last Name:PURKINS
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 1:339 N 3RD ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-1110
Mailing Address - Country:US
Mailing Address - Phone:502-235-4442
Mailing Address - Fax:
Practice Address - Street 1:339 N 3RD ST UNIT 1
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1110
Practice Address - Country:US
Practice Address - Phone:502-235-4442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15334225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist