Healthcare Provider Details

I. General information

NPI: 1386501765
Provider Name (Legal Business Name): SPORTS PHYSICAL THERAPY OCCUPATIONAL THERAPY AND REHABILITATION SERVIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 LAKEVILLE RD STE 303
NEW HYDE PARK NY
11042-1104
US

IV. Provider business mailing address

972 BRUSH HOLLOW RD FL 4
WESTBURY NY
11590-1740
US

V. Phone/Fax

Practice location:
  • Phone: 516-321-7526
  • Fax:
Mailing address:
  • Phone: 516-321-7526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: BRIAN KREBS
Title or Position: VICE PRESIDENT
Credential: PT, DPT
Phone: 516-393-8858