MEDICARE: KENDRIA WERNER 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	4617	ID

General Provider Information

NPI Number	:	1992253462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRIA WERNER PTA

Provider Business Mailing Address
First Line	:	1821 S JUNIPER ST
Second Line	:	APT. C24
City	:	NAMPA
State	:	ID
Zip	:	83686-6176
Country	:	US
Telephone Number	:	208-409-2179
Fax Number	:

Provider Business Practice Location Address
First Line	:	1019 3RD AVE S
Second Line	:
City	:	PAYETTE
State	:	ID
Zip	:	83661-2832
Country	:	US
Telephone Number	:	208-642-4455
Fax Number	:

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

Provider Enumeration Date	:	09/14/2016
Last Update Date	:	09/14/2016

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Directions to “ KENDRIA WERNER PTA” Practice Location

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