Healthcare Provider Details

I. General information

NPI: 1063454577
Provider Name (Legal Business Name): SPEAR PHYSICAL AND OCCUPATIONAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 56TH ST SUITE 1010
NEW YORK NY
10022-3607
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 212-759-2211
  • Fax: 212-829-1189
Mailing address:
  • Phone: 212-759-2282
  • Fax: 212-379-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number017761-1
License Number StateNY

VIII. Authorized Official

Name: DANIEL ROOTENBERG
Title or Position: OWNER
Credential: PT, DPT
Phone: 212-759-2211