Provider Demographics
NPI:1336174424
Name:ANDRUS, JONATHAN H (PT)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:H
Last Name:ANDRUS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 NORWOOD AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764
Mailing Address - Country:US
Mailing Address - Phone:732-923-1500
Mailing Address - Fax:732-923-1510
Practice Address - Street 1:232 NORWOOD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764
Practice Address - Country:US
Practice Address - Phone:732-923-1500
Practice Address - Fax:732-923-1510
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA009643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ050457R3ZMedicare ID - Type Unspecified