Healthcare Provider Details

I. General information

NPI: 1164875209
Provider Name (Legal Business Name): SPEAR PHYSICAL AND OCCUPATIONAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BROAD ST LEVEL A
NEW YORK NY
10004-2304
US

IV. Provider business mailing address

307 5TH AVE FL 6
NEW YORK NY
10016-6575
US

V. Phone/Fax

Practice location:
  • Phone: 646-790-7454
  • Fax: 212-379-2076
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 Number028851-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number035068-1
License Number StateNY

VIII. Authorized Official

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