Provider Demographics
NPI:1386505931
Name:MOSLEY, MELANIE JULYNN (PTA)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:JULYNN
Last Name:MOSLEY
Suffix:
Gender:F
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:PO BOX 3390
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-3390
Mailing Address - Country:US
Mailing Address - Phone:307-682-4900
Mailing Address - Fax:307-682-4996
Practice Address - Street 1:1013 E BOXELDER RD
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5923
Practice Address - Country:US
Practice Address - Phone:307-682-4900
Practice Address - Fax:307-682-4996
Is Sole Proprietor?:No
Enumeration Date:2025-11-22
Last Update Date:2025-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPTA-0394225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant