Provider Demographics
NPI:1124219126
Name:STRAUB, ILENE (CRT)
Entity Type:Individual
Prefix:MS
First Name:ILENE
Middle Name:
Last Name:STRAUB
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 N 51ST ST
Mailing Address - Street 2:2 FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-2726
Mailing Address - Country:US
Mailing Address - Phone:215-688-6595
Mailing Address - Fax:
Practice Address - Street 1:61 N 51ST ST
Practice Address - Street 2:2 FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-2726
Practice Address - Country:US
Practice Address - Phone:215-688-6595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAYO000277L227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified