Provider Demographics
NPI:1467605287
Name:STIASNY, IRINA MARKOVNA (DPT)
Entity Type:Individual
Prefix:MRS
First Name:IRINA
Middle Name:MARKOVNA
Last Name:STIASNY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SOQUEL WAY
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-4102
Mailing Address - Country:US
Mailing Address - Phone:408-736-7600
Mailing Address - Fax:408-736-7604
Practice Address - Street 1:333 SOQUEL WAY
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4102
Practice Address - Country:US
Practice Address - Phone:408-736-7600
Practice Address - Fax:408-736-7604
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA86-1103011OtherTAX ID
CA1053320325OtherGROUP NPI
CADR6649OtherMEDICARE RAILROAD GROUP PIN
CAP01509663OtherMEDICARE RAILROAD IDIVIDUAL UPIN
CA1053320325OtherGROUP NPI