Individual
JONELLE FREDERICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
12100 WORNALL RD, KANSAS CITY, MO 64145-1764
(816) 214-6912
Mailing address
12100 WORNALL RD, KANSAS CITY, MO 64145-1764
(816) 214-6912
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2009036048
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2009036048
STATE OF MISSOURI CERTIFICATE/LICENSE
MO
Enumeration date
04/20/2017
Last updated
04/20/2017
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