Provider Demographics
NPI:1891008868
Name:YAGNETINSKY, YANINA ALEX (DPT)
Entity Type:Individual
Prefix:
First Name:YANINA
Middle Name:ALEX
Last Name:YAGNETINSKY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:YANINA
Other - Middle Name:ALEX
Other - Last Name:GORNAYEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:61 BOSWELL RD
Mailing Address - Street 2:
Mailing Address - City:PUTNAM VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10579-2810
Mailing Address - Country:US
Mailing Address - Phone:845-603-6339
Mailing Address - Fax:845-603-6339
Practice Address - Street 1:317 NORTH ST
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2209
Practice Address - Country:US
Practice Address - Phone:914-597-4035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031906-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist