MEDICARE: JONATHAN WILSON ROSARIO P.T.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	5651	CA

General Provider Information

NPI Number	:	1306853148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN WILSON ROSARIO P.T.A.

Provider Business Mailing Address
First Line	:	15302 EL PRADO RD
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-7659
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15302 EL PRADO RD
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-7659
Country	:	US
Telephone Number	:	909-606-8220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	04/05/2023

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