Provider Demographics
NPI:1780232686
Name:SPELLS, ANWAR (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ANWAR
Middle Name:
Last Name:SPELLS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 PENINSULA BLVD
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3225
Mailing Address - Country:US
Mailing Address - Phone:718-795-7331
Mailing Address - Fax:
Practice Address - Street 1:295 PENINSULA BLVD
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3225
Practice Address - Country:US
Practice Address - Phone:718-795-7331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042180-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist