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NPI Code Detail

MEDICARE: SPORTS PHYSICAL THERAPY OCCUPATIONAL THERAPY AND REHABILITATION SERVIC

MEDICARE: SPORTS PHYSICAL THERAPY OCCUPATIONAL THERAPY AND REHABILITATION SERVIC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XH1200XHand Occupational Therapist

General Provider Information

NPI Number : 1780202192
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPORTS PHYSICAL THERAPY OCCUPATIONAL THERAPY AND REHABILITATION SERVIC
Provider Business Mailing Address
First Line : 3 HUNTINGTON QUADRANGLE STE 103N
Second Line :
City : MELVILLE
State : NY
Zip : 11747-4601
Country : US
Telephone Number : 516-474-2816
Fax Number :
Provider Business Practice Location Address
First Line : 3311 HYLAN BLVD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10306-3611
Country : US
Telephone Number : 718-448-3210
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT
Name : DANIEL VAKNIN
Credential : PT
Telephone Number : 516-321-7801
Provider Enumeration Date : 07/12/2020
Last Update Date : 12/08/2022

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Directions to “SPORTS PHYSICAL THERAPY OCCUPATIONAL THERAPY AND REHABILITATION SERVIC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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