Provider Demographics
NPI:1487980207
Name:SEARS, LYDIA KRISTINA
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:KRISTINA
Last Name:SEARS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10719 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-5731
Mailing Address - Country:US
Mailing Address - Phone:936-537-2453
Mailing Address - Fax:
Practice Address - Street 1:15260 HIGHWAY 105 W
Practice Address - Street 2:SUITE 125
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-5259
Practice Address - Country:US
Practice Address - Phone:936-570-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT100639225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist