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General NPI Number Information
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NPI Number | 1922733328
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Entity Type | Organization
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Legal Business Name | SPECTRUM PHYSICAL THERAPY & CHIROPRACTIC OF MASSAPEQUA, PLLC
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Dates
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Enumeration Date | 07/19/2022
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 3272 HEMPSTEAD TPKE
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City | LEVITTOWN
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State | NY
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Zip | 11756-1345
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Country | US
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Telephone | 516-731-1980
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Fax | 516-731-2999
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Provider Business Mailing Address
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Address Line | 3272 HEMPSTEAD TPKE
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City | LEVITTOWN
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State | NY
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Zip | 11756-1345
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Country | US
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Telephone | 516-731-1980
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Fax | 516-731-2999
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAYMOND E BOWLES
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Credential |
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Telephone | 516-731-1980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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