=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114825122
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANU PELVIC PHYSICAL THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2026
-----------------------------------------------------
Last Update Date | 10/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 MAIN ST STE 1
-----------------------------------------------------
City | IRVINGTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10533-1538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-729-5168
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 E 704TH ST
-----------------------------------------------------
City | ORANGEBURG
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10962-2801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-729-5168
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICAL THERAPIST
-----------------------------------------------------
Name | DR. JUSTINE WARD
-----------------------------------------------------
Credential | PT, DPT, PWCS
-----------------------------------------------------
Telephone | 585-729-5168
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------