Provider Demographics
NPI:1174965842
Name:YINGLING, LISA MARIE (PTA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:YINGLING
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 1:812 TERRADYNE CIR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-9203
Mailing Address - Country:US
Mailing Address - Phone:316-200-8838
Mailing Address - Fax:
Practice Address - Street 1:6700 E 45TH ST N
Practice Address - Street 2:
Practice Address - City:BEL AIRE
Practice Address - State:KS
Practice Address - Zip Code:67226-8817
Practice Address - Country:US
Practice Address - Phone:316-744-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1402378225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant