Jenny Petrenko, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

3526 Issued in SC

Practice address

111 Wellmore Dr
Tega Cay, SC 29708-0124

Phone

(803) 836-7026

NPI assigned

Apr 5, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Ievgeniia Khodas Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470700800000",
    "number": "1588028682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 WELLMORE DR",
            "city": "TEGA CAY",
            "state": "SC",
            "postal_code": "297080124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 WELLMORE DR",
            "city": "TEGA CAY",
            "state": "SC",
            "postal_code": "297080124",
            "telephone_number": "803-836-7026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRENKO",
        "first_name": "JENNY",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-05",
        "last_updated": "2016-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NC",
            "license": "A5776",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "SC",
            "license": "3526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IEVGENIIA",
            "last_name": "KHODAS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Omara Health and Wellness
• Ian Patrick Orr, DC
• Kristen Packard
• Samir Dilip Patel, D.M.D.
• Marcia Marie Patete
• Kimberly Kay Philbrick, OTR/L
• Faith Plemmons, COTA/L
• Pamela Pompey
• Shannon Powers-Jones, RD, LDN
• Alexis Reale, LCMHCA

• All providers in Tega Cay, SC
• Physical Therapy Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.