Provider Demographics
NPI:1699734178
Name:ALBURO, LEOLYN D (PT)
Entity type:Individual
Prefix:
First Name:LEOLYN
Middle Name:D
Last Name:ALBURO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:D
Other - Last Name:ALBURO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:3125 CALUMET AVENUE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383
Mailing Address - Country:US
Mailing Address - Phone:219-548-8770
Mailing Address - Fax:219-548-8771
Practice Address - Street 1:3125 CALUMET AVENUE
Practice Address - Street 2:SUITE 9
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383
Practice Address - Country:US
Practice Address - Phone:219-548-8770
Practice Address - Fax:219-548-8771
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004759A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN203440CMedicare PIN