Healthcare Provider Details

I. General information

NPI: 1750862199
Provider Name (Legal Business Name): JACOB ANDREW HEPLER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 FOXHUNT DR
BEAR DE
19701-2536
US

IV. Provider business mailing address

216 RIVEREDGE DR
NEW CASTLE DE
19720-8703
US

V. Phone/Fax

Practice location:
  • Phone: 302-834-8650
  • Fax:
Mailing address:
  • Phone: 609-202-0292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1310846
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberJ1-0014294
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: