Provider Demographics
NPI:1417146614
Name:NY SPORTS AND SPINAL PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:NY SPORTS AND SPINAL PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KARN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIKUL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:914-396-4273
Mailing Address - Street 1:71 GLEN ROAD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-3617
Mailing Address - Country:US
Mailing Address - Phone:914-396-4273
Mailing Address - Fax:914-779-3152
Practice Address - Street 1:7 POPHAM RD
Practice Address - Street 2:SUITE 302
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3709
Practice Address - Country:US
Practice Address - Phone:914-396-4273
Practice Address - Fax:914-779-3152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026668-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ16P42Q331Medicare PIN