Healthcare Provider Details

I. General information

NPI: 1073426789
Provider Name (Legal Business Name): TORI JURCZYK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 LINDEN AVE STE 245
DAYTON OH
45432-3049
US

IV. Provider business mailing address

6024 9TH AVE
MIAMISBURG OH
45342-5127
US

V. Phone/Fax

Practice location:
  • Phone: 937-716-1791
  • Fax:
Mailing address:
  • Phone: 314-203-4914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: