Spark Physical Therapy PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

SPARK PHYSICAL THERAPY PLLC

Practice address

1763 Dutch Broadway
Elmont, NY 11003-5044

Phone

(516) 812-6145

Fax

(516) 812-6144

NPI assigned

Dec 22, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Randolph D BendoNPI 1679858740

Title

Owner

Phone

(516) 812-6145

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Randolph Bendo, PT

  • Physical Therapist
  • Elmhurst, NY
  • NPI 1679858740
  Medicare reassignment NPD Authorized official
• Jennilyn Roberts, PT

  • Physical Therapist
  • Chesterfield, MI
  • NPI 1083957112
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1671667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671667200000",
    "number": "1861104705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1763 DUTCH BROADWAY",
            "city": "ELMONT",
            "state": "NY",
            "postal_code": "110035044",
            "telephone_number": "516-812-6145",
            "fax_number": "516-812-6144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1763 DUTCH BROADWAY",
            "city": "ELMONT",
            "state": "NY",
            "postal_code": "110035044",
            "telephone_number": "516-812-6145",
            "fax_number": "516-812-6144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARK PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-22",
        "last_updated": "2022-12-22",
        "certification_date": "2022-12-22",
        "status": "A",
        "authorized_official_last_name": "BENDO",
        "authorized_official_first_name": "RANDOLPH",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-812-6145"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marilyn Ann Soeder, LCSW-R
• Zachary Spencer Sonkin, D.D.S.
• Olufunke Sotannde
• South Shore Medical Professionals P.C.
• Varda Souverain
• Spinal Chirporactic Diagnostics
• Soeurette St Albert
• Karen Elizabeth Staple, FNP
• State of the Art Physical Therapy Rehabilitation,P.C.
• Jenna Stewart, M.A, CCC-SLP, TSSLD

• Physical Therapist in Elmont, NY
• Providers in Elmont, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.