Provider Demographics
NPI:1316086986
Name:MILBURN, SANDRA MEADOWS (PT)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MEADOWS
Last Name:MILBURN
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:5920 TIMBER RIDGE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8151
Mailing Address - Country:US
Mailing Address - Phone:502-451-2142
Mailing Address - Fax:502-451-2740
Practice Address - Street 1:5920 TIMBER RIDGE DR STE 201
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-8151
Practice Address - Country:US
Practice Address - Phone:502-451-2142
Practice Address - Fax:502-451-2740
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1904225100000X
KY0019042251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1463OtherCBIS PROVIDER NUMBER