Provider Demographics
NPI:1487963229
Name:BECKNER, IRINA P (DPT)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:P
Last Name:BECKNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:IRINA
Other - Middle Name:P
Other - Last Name:LYAMIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:12600 SE 38TH ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-6105
Mailing Address - Country:US
Mailing Address - Phone:425-728-8363
Mailing Address - Fax:425-679-6632
Practice Address - Street 1:12600 SE 38TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-6105
Practice Address - Country:US
Practice Address - Phone:425-728-8363
Practice Address - Fax:425-679-6632
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60173492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist