Provider Demographics
NPI:1255716627
Name:DALEY, JONATHAN (PTA)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:DALEY
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 1:19 CHARLES ST
Mailing Address - Street 2:19 CHARLES ST
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-3112
Mailing Address - Country:US
Mailing Address - Phone:603-504-6531
Mailing Address - Fax:
Practice Address - Street 1:24 OLD ETNA RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1937
Practice Address - Country:US
Practice Address - Phone:603-488-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1194225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant