Provider Demographics
NPI:1700254695
Name:JURADO, JAN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:JURADO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CONTINENTAL CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08882-2586
Mailing Address - Country:US
Mailing Address - Phone:732-318-9869
Mailing Address - Fax:
Practice Address - Street 1:300 HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1912
Practice Address - Country:US
Practice Address - Phone:732-254-3971
Practice Address - Fax:732-254-5291
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01631000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist