Provider Demographics
NPI:1417462755
Name:SPORTS PHYSICAL THERAPY OCCUPATIONAL THERAPY AND REHABILITATION SERVIC
Entity Type:Organization
Organization Name:SPORTS PHYSICAL THERAPY OCCUPATIONAL THERAPY AND REHABILITATION SERVIC
Other - Org Name:SPORTS THERAPY AND REHABILITATION SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAKNIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, VP
Authorized Official - Phone:516-321-7801
Mailing Address - Street 1:3 HUNTINGTON QUADRANGLE STE 103N
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4601
Mailing Address - Country:US
Mailing Address - Phone:516-474-2816
Mailing Address - Fax:516-321-7830
Practice Address - Street 1:95-25 QUEENS BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:718-925-6212
Practice Address - Fax:718-925-6271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty