1780202192 NPI number — SPORTS PHYSICAL THERAPY OCCUPATIONAL THERAPY AND REHABILITATION SERVIC

Table of content: SARAH ANNE JOHNSON MFTI (NPI 1578873626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780202192 NPI number — SPORTS PHYSICAL THERAPY OCCUPATIONAL THERAPY AND REHABILITATION SERVIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPORTS PHYSICAL THERAPY OCCUPATIONAL THERAPY AND REHABILITATION SERVIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780202192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
972 BRUSH HOLLOW RD FL 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTBURY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11590-1740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-474-2816
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3311 HYLAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10306-3611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-448-3210
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2020

Additional Information

Authorized Official

Authorized Official Last Name:
KREBS
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
516-321-7805

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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