Healthcare Provider Details

I. General information

NPI: 1518822147
Provider Name (Legal Business Name): SPARK HEALTH PHYSICAL THERAPY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CHENANGO DR
JERICHO NY
11753-1504
US

IV. Provider business mailing address

26 CHENANGO DR
JERICHO NY
11753-1504
US

V. Phone/Fax

Practice location:
  • Phone: 570-903-9008
  • Fax:
Mailing address:
  • Phone: 570-903-9008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. SNEHA SURESH DHARESHWAR
Title or Position: PRESIDENT & CEO
Credential: MPT, DPT
Phone: 570-903-9097