=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376424457
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPEECH THERAPY REHABILITATION SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2025
-----------------------------------------------------
Last Update Date | 10/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 972 BRUSH HOLLOW RD FL 4
-----------------------------------------------------
City | WESTBURY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11590-1740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-321-7526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 972 BRUSH HOLLOW RD FL 4
-----------------------------------------------------
City | WESTBURY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11590-1740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-321-7526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP, STARS OPERATIONS
-----------------------------------------------------
Name | BRIAN KREBS
-----------------------------------------------------
Credential | PT, DPT
-----------------------------------------------------
Telephone | 516-321-7805
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------