Provider Demographics
NPI:1659906246
Name:JURASEVICH, JESSICA N (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:N
Last Name:JURASEVICH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:N
Other - Last Name:HAVERSTOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:4602 GOLDEN HINDE WAY
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46062-6980
Mailing Address - Country:US
Mailing Address - Phone:219-671-6349
Mailing Address - Fax:
Practice Address - Street 1:11854 ALLISONVILLE RD STE F
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2312
Practice Address - Country:US
Practice Address - Phone:317-845-9628
Practice Address - Fax:317-845-9740
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05015300A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist