Provider Demographics
NPI:1467773150
Name:BRANDON SPAHN PT PLLC
Entity Type:Organization
Organization Name:BRANDON SPAHN PT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:SPAHN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:631-991-3311
Mailing Address - Street 1:155 W SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2434
Mailing Address - Country:US
Mailing Address - Phone:631-991-3311
Mailing Address - Fax:631-991-3309
Practice Address - Street 1:155 W SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2434
Practice Address - Country:US
Practice Address - Phone:631-991-3311
Practice Address - Fax:631-991-3309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029010261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400019109Medicare PIN