Provider Demographics
NPI:1417226432
Name:JURALBAL, ETHEL SUNRISE
Entity Type:Individual
Prefix:
First Name:ETHEL
Middle Name:SUNRISE
Last Name:JURALBAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ETHEL SUNRISE
Other - Middle Name:DELA CRUZ
Other - Last Name:JURALBAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1606 E 50TH PL
Mailing Address - Street 2:APT 6D
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-3196
Mailing Address - Country:US
Mailing Address - Phone:773-753-9867
Mailing Address - Fax:
Practice Address - Street 1:2425 E 71ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-2612
Practice Address - Country:US
Practice Address - Phone:773-721-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist