Healthcare Provider Details

I. General information

NPI: 1801672365
Provider Name (Legal Business Name): JAKE THOMAS MOSKAL PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9070 KIMBERLY BLVD STE 24
BOCA RATON FL
33434-2861
US

IV. Provider business mailing address

9070 KIMBERLY BLVD STE 24
BOCA RATON FL
33434-2861
US

V. Phone/Fax

Practice location:
  • Phone: 561-482-6900
  • Fax: 561-482-6023
Mailing address:
  • Phone: 561-482-6900
  • Fax: 561-482-6023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA29028
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: