Individual
JAN WILLIAM DURST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1075 N MAIN ST, MADISONVILLE, KY 42431-1288
(812) 476-0409
(812) 476-1016
Mailing address
7300 E INDIANA ST, SUITE 102, EVANSVILLE, IN 47715-2794
(812) 476-0409
(812) 476-1016
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
002363
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002363
KENTUCKY STATE LICENSE
KY
Enumeration date
07/30/2007
Last updated
03/26/2010
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