Provider Demographics
NPI:1013979749
Name:JURY, JOHN E (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:JURY
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 1:65 SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1855
Mailing Address - Country:US
Mailing Address - Phone:413-568-1388
Mailing Address - Fax:413-568-1389
Practice Address - Street 1:65 SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1855
Practice Address - Country:US
Practice Address - Phone:413-568-1388
Practice Address - Fax:413-568-1389
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY67876OtherBCBS
MA0332551Medicaid
Y68691Medicare PIN