Provider Demographics
NPI:1306469226
Name:NURCZYK, JOHN PAUL (MPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:NURCZYK
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 NW BINGHAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-3434
Mailing Address - Country:US
Mailing Address - Phone:772-777-0888
Mailing Address - Fax:
Practice Address - Street 1:302 NW BINGHAMPTON LN
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-3434
Practice Address - Country:US
Practice Address - Phone:772-777-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22515225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty