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General NPI Number Information
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NPI Number | 1235578873
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Entity Type | Individual
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Provider Name | LYDIA FERNANDEZ P.T.A.
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Gender | Female
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Dates
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Enumeration Date | 06/17/2013
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 1333 MEADOWLARK LN SUITE 200
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City | KANSAS CITY
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State | KS
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Zip | 66102-1260
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Country | US
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Telephone | 913-596-2774
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Fax | 913-596-2890
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Provider Business Mailing Address
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Address Line | 1333 MEADOWLARK LN SUITE 200
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City | KANSAS CITY
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State | KS
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Zip | 66102-1260
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Country | US
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Telephone | 913-596-2774
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Fax | 913-596-2890
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 14-01669
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2003000922
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License Number State | MO
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