Provider Demographics
NPI:1235507336
Name:JUROVCIK, KRYSTEL N (DPT)
Entity Type:Individual
Prefix:
First Name:KRYSTEL
Middle Name:N
Last Name:JUROVCIK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRYSTEL
Other - Middle Name:M
Other - Last Name:NOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:88 DOUBLE OAK AVE
Mailing Address - Street 2:
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064-3890
Mailing Address - Country:US
Mailing Address - Phone:850-238-2886
Mailing Address - Fax:
Practice Address - Street 1:8117 OLD FEDERAL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8009
Practice Address - Country:US
Practice Address - Phone:334-380-5920
Practice Address - Fax:708-444-2758
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070021837225100000X
FLPT 30606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist