Provider Demographics
NPI:1306528468
Name:JURAS, KENNETH ALLAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:ALLAN
Last Name:JURAS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KENNETH
Other - Middle Name:ALLAN
Other - Last Name:JURAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:26405 BARNES ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-3522
Mailing Address - Country:US
Mailing Address - Phone:586-553-4088
Mailing Address - Fax:
Practice Address - Street 1:3300 RIVERMONT AVE
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2030
Practice Address - Country:US
Practice Address - Phone:434-200-4618
Practice Address - Fax:434-200-1294
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225100000X
FLPT40914225100000X
VA2305216210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist