Provider Demographics
NPI:1306052691
Name:DEKHTYAR, IRINA (PT)
Entity type:Individual
Prefix:MS
First Name:IRINA
Middle Name:
Last Name:DEKHTYAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 BAY 20TH ST APT 1C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4667
Mailing Address - Country:US
Mailing Address - Phone:718-621-2498
Mailing Address - Fax:
Practice Address - Street 1:445 LENOX ROAD, BOX 30
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2098
Practice Address - Country:US
Practice Address - Phone:718-270-2811
Practice Address - Fax:718-270-1247
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist