Provider Demographics
NPI:1073116083
Name:JURCENKO, ALYSON GATES (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:GATES
Last Name:JURCENKO
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 1:7553 BLUE FESCUE DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9169
Mailing Address - Country:US
Mailing Address - Phone:614-581-1339
Mailing Address - Fax:
Practice Address - Street 1:738 W COSHOCTON ST STE B
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031-9581
Practice Address - Country:US
Practice Address - Phone:740-200-4221
Practice Address - Fax:740-966-3512
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist