Healthcare Provider Details

I. General information

NPI: 1003220575
Provider Name (Legal Business Name): TIMOTHY JURNAK ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 GROVE ST
AVOCA PA
18641-1615
US

IV. Provider business mailing address

831 GROVE ST
AVOCA PA
18641-1615
US

V. Phone/Fax

Practice location:
  • Phone: 570-241-2241
  • Fax:
Mailing address:
  • Phone: 570-241-2241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: