Provider Demographics
NPI:1194923284
Name:WINGATE, JON A (PTA)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:A
Last Name:WINGATE
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 W PENN AVE
Mailing Address - Street 2:
Mailing Address - City:ROBESONIA
Mailing Address - State:PA
Mailing Address - Zip Code:19551-1504
Mailing Address - Country:US
Mailing Address - Phone:610-693-6184
Mailing Address - Fax:
Practice Address - Street 1:100 W PENN AVE
Practice Address - Street 2:
Practice Address - City:ROBESONIA
Practice Address - State:PA
Practice Address - Zip Code:19551-1504
Practice Address - Country:US
Practice Address - Phone:610-693-6184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE002308L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant