Healthcare Provider Details

I. General information

NPI: 1699734178
Provider Name (Legal Business Name): LEOLYN D ALBURO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANE D ALBURO PT

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 CALUMET AVENUE SUITE 9
VALPARAISO IN
46383
US

IV. Provider business mailing address

3125 CALUMET AVENUE SUITE 9
VALPARAISO IN
46383
US

V. Phone/Fax

Practice location:
  • Phone: 219-548-8770
  • Fax: 219-548-8771
Mailing address:
  • Phone: 219-548-8770
  • Fax: 219-548-8771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05004759A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: