MEDICARE: JENNIFER JOAN KUREK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	06002486A	IN

General Provider Information

NPI Number	:	1417674672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JOAN KUREK

Provider Business Mailing Address
First Line	:	12224 SANCTUARY TRL
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46814-3263
Country	:	US
Telephone Number	:	260-579-1351
Fax Number	:

Provider Business Practice Location Address
First Line	:	12224 SANCTUARY TRL
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46814-3263
Country	:	US
Telephone Number	:	260-579-1351
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2022
Last Update Date	:	10/27/2022

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Directions to “ JENNIFER JOAN KUREK ” Practice Location

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