Doctor Name: | MR. JARED COLE WILBURN |
NPI Number: | 1760704431 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MPT |
License Number: | 05009495A |
Business Practice Address: | 525 Alexandria Pike Suite 200 Southgate, KY - 410713290 |
Business Phone Number: | 8594417913 |
Business Fax Number: | 8594414944 |
Mailing Address: | 560 S Loop Rd, EDGEWOOD |
State: | KY |
Postal Code: | 410173405 |
Phone Number: | 8593012663 |
Fax Number: | 8593010655 |
NPI Enumeration Date: | 02/23/2010 |
NPI Last Update Date: | 05/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 05009495A |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IN |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |