Basic Information
| Provider Information | |||||||||
| NPI: | 1134663909 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPEAR PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 E 56TH ST | ||||||||
| Address2: | SUITE 835 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100223607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6467907465 | ||||||||
| FaxNumber: | 2123792077 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 WATERS PLACE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127592282 | ||||||||
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| ProviderEnumerationDate: | 12/13/2016 | ||||||||
| LastUpdateDate: | 12/13/2016 | ||||||||
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| AuthorizedOfficialLastName: | PENNACCHIO | ||||||||
| AuthorizedOfficialFirstName: | FRED | ||||||||
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| AuthorizedOfficialTitleorPosition: | HUMAN RESOURCES | ||||||||
| AuthorizedOfficialTelephone: | 6467907465 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251H1200X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.