Provider Demographics
NPI:1881678761
Name:WATROUS, ILENE S (PT)
Entity Type:Individual
Prefix:MRS
First Name:ILENE
Middle Name:S
Last Name:WATROUS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 CRANBURY RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-1205
Mailing Address - Country:US
Mailing Address - Phone:609-799-5204
Mailing Address - Fax:609-799-5205
Practice Address - Street 1:131 CRANBURY RD
Practice Address - Street 2:
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-1205
Practice Address - Country:US
Practice Address - Phone:609-799-5204
Practice Address - Fax:609-799-5205
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00312200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ442524Medicare ID - Type Unspecified