Provider Demographics
NPI:1669497400
Name:SPRAIN BROOK PHYSICAL THERAPY,P.C.
Entity Type:Organization
Organization Name:SPRAIN BROOK PHYSICAL THERAPY,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:914-328-2036
Mailing Address - Street 1:297 KNOLLWOOD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1833
Mailing Address - Country:US
Mailing Address - Phone:914-328-2036
Mailing Address - Fax:914-328-2038
Practice Address - Street 1:297 KNOLLWOOD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1833
Practice Address - Country:US
Practice Address - Phone:914-328-2036
Practice Address - Fax:914-328-2038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ1W941Medicare ID - Type Unspecified