Healthcare Provider Details

I. General information

NPI: 1134663909
Provider Name (Legal Business Name): SPEAR PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 WATERS PLACE
BRONX NY
10461
US

IV. Provider business mailing address

120 E 56TH ST SUITE 835
NEW YORK NY
10022-3607
US

V. Phone/Fax

Practice location:
  • Phone: 212-759-2282
  • Fax:
Mailing address:
  • Phone: 646-790-7465
  • Fax: 212-379-2077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: FRED PENNACCHIO
Title or Position: HUMAN RESOURCES
Credential:
Phone: 646-790-7465