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NPI Code Detail

MEDICARE: JONELLE FREDERICO LPTA

MEDICARE: JONELLE FREDERICO LPTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant2009036048MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12009036048OTHERMOSTATE OF MISSOURI CERTIFICATE/LICENSE

General Provider Information

NPI Number : 1023542651
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONELLE FREDERICO LPTA
Provider Business Mailing Address
First Line : 12100 WORNALL RD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64145-1764
Country : US
Telephone Number : 816-214-6912
Fax Number :
Provider Business Practice Location Address
First Line : 12100 WORNALL RD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64145-1764
Country : US
Telephone Number : 816-214-6912
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2017
Last Update Date : 04/20/2017

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Directions to “ JONELLE FREDERICO LPTA” Practice Location

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