Provider Demographics
NPI:1609209618
Name:KEPLER, LYDIA MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:MARIE
Last Name:KEPLER
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 1:17191 JENNIFER ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-9215
Mailing Address - Country:US
Mailing Address - Phone:816-878-4209
Mailing Address - Fax:
Practice Address - Street 1:17191 JENNIFER ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-9215
Practice Address - Country:US
Practice Address - Phone:816-878-4209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant