Provider Demographics
NPI:1235578873
Name:FERNANDEZ, LYDIA (PTA)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:FERNANDEZ
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 1:1333 MEADOWLARK LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-1260
Mailing Address - Country:US
Mailing Address - Phone:913-596-2774
Mailing Address - Fax:913-596-2890
Practice Address - Street 1:1333 MEADOWLARK LN
Practice Address - Street 2:SUITE 200
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1260
Practice Address - Country:US
Practice Address - Phone:913-596-2774
Practice Address - Fax:913-596-2890
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01669225200000X
MO2003000922225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant