Individual
JONATHAN O SALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2601 FERRY ST, LAFAYETTE, IN 47904-3061
(765) 448-8000
(765) 448-8335
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
(765) 448-8335
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06001921A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000188968
ANTHEM PROVIDER NUMBER
IN
05
—
100099590
—
IN
Enumeration date
10/12/2006
Last updated
05/10/2010
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