Healthcare Provider Details

I. General information

NPI: 1609756360
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: 09/04/2025
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 BOULEVARD E BLDG B SUITE 101
YAPHANK NY
11980-7515
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 516-536-3800
  • Fax:
Mailing address:
  • Phone: 516-321-7526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BRIAN KREBS
Title or Position: VP, STARS OPERATIONS
Credential:
Phone: 516-321-7805