Healthcare Provider Details

I. General information

NPI: 1942372180
Provider Name (Legal Business Name): BEVERLY BROWN DURBOROW M.S., P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 YORKSHIRE MEDICAL PARK
LEXINGTON KY
40509
US

IV. Provider business mailing address

3480 YORKSHIRE MEDICAL PARK
LEXINGTON KY
40509-1886
US

V. Phone/Fax

Practice location:
  • Phone: 859-263-5140
  • Fax: 859-263-5141
Mailing address:
  • Phone: 859-263-5140
  • Fax: 859-263-5141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number001815
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001815
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: