Provider Demographics
NPI:1417674672
Name:KUREK, JENNIFER JOAN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOAN
Last Name:KUREK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12224 SANCTUARY TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-3263
Mailing Address - Country:US
Mailing Address - Phone:260-579-1351
Mailing Address - Fax:
Practice Address - Street 1:12224 SANCTUARY TRL
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-3263
Practice Address - Country:US
Practice Address - Phone:260-579-1351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002486A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant