Provider Demographics
NPI:1366223489
Name:STILES, JONATHAN (PTA)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:STILES
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 1:100 LOCKHOUSE RD APT G1
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1288
Mailing Address - Country:US
Mailing Address - Phone:413-563-4712
Mailing Address - Fax:
Practice Address - Street 1:39 CARLON DR
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2392
Practice Address - Country:US
Practice Address - Phone:413-727-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9909225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant