Provider Demographics
NPI:1184807596
Name:KALUSA, IVY (PT)
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:
Last Name:KALUSA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:IVY
Other - Middle Name:
Other - Last Name:DE CHAVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2249 LEON CT
Mailing Address - Street 2:
Mailing Address - City:ATCO
Mailing Address - State:NJ
Mailing Address - Zip Code:08004-2821
Mailing Address - Country:US
Mailing Address - Phone:609-678-6536
Mailing Address - Fax:
Practice Address - Street 1:114 HAYES MILL RD
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-2457
Practice Address - Country:US
Practice Address - Phone:856-753-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01205000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist