Provider Demographics
NPI:1275005076
Name:KONDRATIUK, INNA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:INNA
Middle Name:
Last Name:KONDRATIUK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:INNA
Other - Middle Name:
Other - Last Name:KRAVCHUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3719 N OLD TRAILS RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-9549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1224 E WESTVIEW CT
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-3813
Practice Address - Country:US
Practice Address - Phone:509-465-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60638081225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty