Provider Demographics
NPI:1063454148
Name:SPECTRUM PHYSICAL THERAPY & CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:SPECTRUM PHYSICAL THERAPY & CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:LORI
Authorized Official - Last Name:HERR
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS
Authorized Official - Phone:516-694-4426
Mailing Address - Street 1:3272 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1345
Mailing Address - Country:US
Mailing Address - Phone:516-731-1980
Mailing Address - Fax:516-731-2999
Practice Address - Street 1:3272 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1345
Practice Address - Country:US
Practice Address - Phone:516-731-1980
Practice Address - Fax:516-731-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007197111N00000X
NY019821225100000X
NY025547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWFW521Medicare PIN