MEDICARE: KRYSTEL N JUROVCIK DPT

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	225100000X	Physical Therapist	070021837	IL
2	225100000X	Physical Therapist	PT 30606	FL

General Provider Information

NPI Number	:	1235507336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTEL N JUROVCIK DPT

Provider Business Mailing Address
First Line	:	88 DOUBLE OAK AVE
Second Line	:
City	:	PIKE ROAD
State	:	AL
Zip	:	36064-3890
Country	:	US
Telephone Number	:	850-238-2886
Fax Number	:

Provider Business Practice Location Address
First Line	:	8117 OLD FEDERAL RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-8009
Country	:	US
Telephone Number	:	334-380-5920
Fax Number	:	708-444-2758

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

Provider Enumeration Date	:	09/04/2015
Last Update Date	:	06/03/2020

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