Provider Demographics
NPI:1053557728
Name:WESOLOSKY, JANE
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:WESOLOSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 BUFFALO PLZ
Mailing Address - Street 2:
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055-8302
Mailing Address - Country:US
Mailing Address - Phone:724-295-0066
Mailing Address - Fax:
Practice Address - Street 1:252 BUFFALO PLZ
Practice Address - Street 2:ROUTE 356
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055-8302
Practice Address - Country:US
Practice Address - Phone:724-295-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE002705L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant