Provider Demographics
NPI:1912950072
Name:SPORTS PHYSICAL THERAPY OF NEW YORK, P.C.
Entity Type:Organization
Organization Name:SPORTS PHYSICAL THERAPY OF NEW YORK, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINDWER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT/DC
Authorized Official - Phone:781-961-3370
Mailing Address - Street 1:703 GRANITE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-5350
Mailing Address - Country:US
Mailing Address - Phone:781-961-3370
Mailing Address - Fax:781-961-1291
Practice Address - Street 1:240 W SENECA ST STE 12
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-2422
Practice Address - Country:US
Practice Address - Phone:315-682-0325
Practice Address - Fax:315-682-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQAW561Medicare PIN
NYQDW252Medicare PIN
NYAA0385Medicare PIN