Provider Demographics
NPI:1740400118
Name:ROUSH, JOAN S (MED, PT)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:S
Last Name:ROUSH
Suffix:
Gender:F
Credentials:MED, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W APSLEY ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3602
Mailing Address - Country:US
Mailing Address - Phone:215-848-5741
Mailing Address - Fax:
Practice Address - Street 1:1030 KINGS HWY N
Practice Address - Street 2:SUITE 210
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1907
Practice Address - Country:US
Practice Address - Phone:856-321-1900
Practice Address - Fax:856-321-1107
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00358600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist