Provider Demographics
NPI:1811016447
Name:JUKES, KRISTINE (PT)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:JUKES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9351 CORKSCREW RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6801
Mailing Address - Country:US
Mailing Address - Phone:239-687-3199
Mailing Address - Fax:855-398-9437
Practice Address - Street 1:9351 CORKSCREW RD STE 103
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-6801
Practice Address - Country:US
Practice Address - Phone:239-687-3199
Practice Address - Fax:855-398-9437
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014637-1225100000X
FLPT38216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist