Provider Demographics
NPI:1992253462
Name:WERNER, KENDRIA (PTA)
Entity type:Individual
Prefix:
First Name:KENDRIA
Middle Name:
Last Name:WERNER
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 1:1821 S JUNIPER ST
Mailing Address - Street 2:APT. C24
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6176
Mailing Address - Country:US
Mailing Address - Phone:208-409-2179
Mailing Address - Fax:
Practice Address - Street 1:1019 3RD AVE S
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-2832
Practice Address - Country:US
Practice Address - Phone:208-642-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4617225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant