MEDICARE: MRS. LYDIA PROTHRO PTA

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
1	225200000X	Physical Therapy Assistant	A10065R	LA
2	225200000X	Physical Therapy Assistant	2141940	TX

General Provider Information

NPI Number	:	1902386915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYDIA PROTHRO PTA

Provider Business Mailing Address
First Line	:	10425 HUFFMEISTER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-3429
Country	:	US
Telephone Number	:	281-664-2126
Fax Number	:

Provider Business Practice Location Address
First Line	:	10425 HUFFMEISTER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-3429
Country	:	US
Telephone Number	:	281-664-2126
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2018
Last Update Date	:	02/03/2026

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