Healthcare Provider Details

I. General information

NPI: 1386505931
Provider Name (Legal Business Name): MELANIE JULYNN MOSLEY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2025
Last Update Date: 11/22/2025
Certification Date: 11/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 E BOXELDER RD
GILLETTE WY
82718-5923
US

IV. Provider business mailing address

PO BOX 3390
GILLETTE WY
82717-3390
US

V. Phone/Fax

Practice location:
  • Phone: 307-682-4900
  • Fax: 307-682-4996
Mailing address:
  • Phone: 307-682-4900
  • Fax: 307-682-4996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-0394
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: