Provider Demographics
NPI:1659677060
Name:JURKEN, VIRGINIA MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:MARIE
Last Name:JURKEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2040 ERIN CT
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-4815
Mailing Address - Country:US
Mailing Address - Phone:262-786-6102
Mailing Address - Fax:262-786-6102
Practice Address - Street 1:700 PILGRIM PKWY
Practice Address - Street 2:SUITE L9
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2063
Practice Address - Country:US
Practice Address - Phone:414-467-6102
Practice Address - Fax:262-786-6102
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1740-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist