Jonelle Frederico, LPTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2009036048 Issued in MO

Practice address

12100 Wornall Rd
Kansas City, MO 64145-1764

Phone

(816) 214-6912

NPI assigned

Apr 20, 2017

Last updated

Apr 20, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1492646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492646400000",
    "number": "1023542651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12100 WORNALL RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641451764",
            "telephone_number": "816-214-6912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12100 WORNALL RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641451764",
            "telephone_number": "816-214-6912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICO",
        "first_name": "JONELLE",
        "credential": "LPTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-20",
        "last_updated": "2017-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "2009036048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF MISSOURI CERTIFICATE/LICENSE",
            "identifier": "2009036048",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Terra Nicole Frazier, DO
• Kimberly Frederich
• Frederick N. Shuler, M.D.,P.C.
• Amy Elizabeth Frederick
• Mindy Ann Frederick, DPT
• Deborah Frederiksen, LPC
• Carolyn Marie Fredrick, LPC
• Charles James Fredricks, D.C.
• Dann J Fredrickson, MD
• Free From Marketplace, Inc.

• Physical Therapy Assistant in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Physical Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.