Provider Demographics
NPI:1184219370
Name:SRETENSKI, IRINA (PTA)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:SRETENSKI
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:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:BURDETT
Mailing Address - State:KS
Mailing Address - Zip Code:67523
Mailing Address - Country:US
Mailing Address - Phone:620-804-0111
Mailing Address - Fax:
Practice Address - Street 1:205 LOCUST ST
Practice Address - Street 2:
Practice Address - City:BURDETT
Practice Address - State:KS
Practice Address - Zip Code:67523-8533
Practice Address - Country:US
Practice Address - Phone:620-804-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03824225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant