Provider Demographics
NPI:1053812024
Name:MOSLEY, JONATHAN WAYNE (PTA)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:WAYNE
Last Name:MOSLEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32006 N MARGINAL DR
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-4490
Mailing Address - Country:US
Mailing Address - Phone:216-659-1492
Mailing Address - Fax:
Practice Address - Street 1:1645 MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5662
Practice Address - Country:US
Practice Address - Phone:330-626-3031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA011147225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant