Provider Demographics
NPI:1285858969
Name:CORDOVA, JUDY SANDRA (PTA)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:SANDRA
Last Name:CORDOVA
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 1:1338 E 90TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BELLE PLAINE
Mailing Address - State:KS
Mailing Address - Zip Code:67013-7936
Mailing Address - Country:US
Mailing Address - Phone:620-488-3999
Mailing Address - Fax:
Practice Address - Street 1:621 W 21ST ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-8498
Practice Address - Country:US
Practice Address - Phone:316-733-1349
Practice Address - Fax:316-733-5883
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01517225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant