Provider Demographics
NPI:1720647910
Name:JURNAK, STEVEN JR
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:JURNAK
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33701 STATE ROAD 52
Mailing Address - Street 2:PO BOX 6665 MSC 2038
Mailing Address - City:SAINT LEO
Mailing Address - State:FL
Mailing Address - Zip Code:33574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33701 STATE ROAD 52
Practice Address - Street 2:
Practice Address - City:SAINT LEO
Practice Address - State:FL
Practice Address - Zip Code:33574-3357
Practice Address - Country:US
Practice Address - Phone:802-399-6948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer