Provider Demographics
NPI:1255590741
Name:JUREK, MATTHEW THOMAS (DPT, CSCS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THOMAS
Last Name:JUREK
Suffix:
Gender:M
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7114
Mailing Address - Country:US
Mailing Address - Phone:541-776-2333
Mailing Address - Fax:541-776-2495
Practice Address - Street 1:36 HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7114
Practice Address - Country:US
Practice Address - Phone:541-776-2333
Practice Address - Fax:541-776-2495
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist