Provider Demographics
NPI:1912440397
Name:AMBROSIUS, KATHERINE ELISE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELISE
Last Name:AMBROSIUS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PHEASANT CIR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08312-1979
Mailing Address - Country:US
Mailing Address - Phone:856-625-0255
Mailing Address - Fax:
Practice Address - Street 1:54 SHARP ST N
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-2444
Practice Address - Country:US
Practice Address - Phone:856-327-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01705300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist