Provider Demographics
NPI:1326544321
Name:ROUBOS, ALICE MARIE HENRY (DPT)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:MARIE HENRY
Last Name:ROUBOS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CHINNICK AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3404
Mailing Address - Country:US
Mailing Address - Phone:609-227-7915
Mailing Address - Fax:
Practice Address - Street 1:124 CHINNICK AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3404
Practice Address - Country:US
Practice Address - Phone:609-227-7915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01642800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty