Provider Demographics
NPI:1548364110
Name:ANDRUS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ANDRUS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ANDRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-923-1500
Mailing Address - Street 1:232 NORWOOD AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEST LONG BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1859
Mailing Address - Country:US
Mailing Address - Phone:732-923-1500
Mailing Address - Fax:732-923-1510
Practice Address - Street 1:232 NORWOOD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:WEST LONG BEACH
Practice Address - State:NJ
Practice Address - Zip Code:07764
Practice Address - Country:US
Practice Address - Phone:732-923-1500
Practice Address - Fax:732-923-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA009638225100000X
NJQA009643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID #
NJ073409Medicare ID - Type Unspecified