Healthcare Provider Details

I. General information

NPI: 1104456904
Provider Name (Legal Business Name): SPEAR PHYSICAL AND OCCUPATIONAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

794 UNION ST
BROOKLYN NY
11215-7724
US

IV. Provider business mailing address

307 5TH AVENUE 6TH FL
NEW YORK NY
10016
US

V. Phone/Fax

Practice location:
  • Phone: 646-841-1402
  • Fax: 212-379-2097
Mailing address:
  • Phone: 212-759-2282
  • Fax: 212-379-2123

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

VIII. Authorized Official

Name: ALLISON RIVERA
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 212-759-2282