Individual
JONATHAN MARSHALL PUDDISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
30 MON GENERAL DR, MORGANTOWN, WV 26505-2853
(304) 598-5151
Mailing address
30 MON GENERAL DR, MORGANTOWN, WV 26505-2853
(304) 598-5151
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA001589
WV
Other
Enumeration date
04/10/2026
Last updated
04/10/2026
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