Individual
MR. JARED COLE WILBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
525 ALEXANDRIA PIKE, SUITE 200, SOUTHGATE, KY 41071-3290
(859) 441-7913
(859) 441-4944
Mailing address
560 S LOOP RD, EDGEWOOD, KY 41017-3405
(859) 301-2663
(859) 301-0655
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
005941
KY
225100000X
Physical Therapist
05009495A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100220980
—
KY
Enumeration date
02/23/2010
Last updated
05/12/2015
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