Provider Demographics
NPI:1649316290
Name:JURAK, CHRISTIAN ALEXANDER (MS, PT)
Entity type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:ALEXANDER
Last Name:JURAK
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 PETERS BLVD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTWATERS
Mailing Address - State:NY
Mailing Address - Zip Code:11718-1726
Mailing Address - Country:US
Mailing Address - Phone:516-859-4514
Mailing Address - Fax:
Practice Address - Street 1:541 PETERS BLVD
Practice Address - Street 2:
Practice Address - City:BRIGHTWATERS
Practice Address - State:NY
Practice Address - Zip Code:11718-1726
Practice Address - Country:US
Practice Address - Phone:516-859-4514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015172225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist