Provider Demographics
NPI:1679983613
Name:SPARC OCCUPATIONAL AND PHYSICAL THERAPY SERVICES
Entity Type:Organization
Organization Name:SPARC OCCUPATIONAL AND PHYSICAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:M
Authorized Official - Last Name:ORLANDO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:585-748-5689
Mailing Address - Street 1:595 BLOSSOM RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-1825
Mailing Address - Country:US
Mailing Address - Phone:585-355-4071
Mailing Address - Fax:585-355-4071
Practice Address - Street 1:595 BLOSSOM RD
Practice Address - Street 2:SUITE 308
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1825
Practice Address - Country:US
Practice Address - Phone:585-355-4071
Practice Address - Fax:585-355-4071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0121872251P0200X
NY003402225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003402OtherSTATE LICENSE NUMBER