Provider Demographics
NPI:1124210679
Name:SPIRA, BRONWYN ANNE (PT)
Entity Type:Individual
Prefix:
First Name:BRONWYN
Middle Name:ANNE
Last Name:SPIRA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 MACDOUGAL ALY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-9103
Mailing Address - Country:US
Mailing Address - Phone:646-415-8632
Mailing Address - Fax:440-445-8632
Practice Address - Street 1:13 MACDOUGAL ALY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-9103
Practice Address - Country:US
Practice Address - Phone:646-415-8632
Practice Address - Fax:440-445-8632
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist