Provider Demographics
NPI:1184681413
Name:HILBURN, MARK E (ATC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:HILBURN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781
Mailing Address - Street 2:
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139-0781
Mailing Address - Country:US
Mailing Address - Phone:606-923-9848
Mailing Address - Fax:
Practice Address - Street 1:709 RED DEVIL LN
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KY
Practice Address - Zip Code:41169-1561
Practice Address - Country:US
Practice Address - Phone:606-836-9658
Practice Address - Fax:606-836-9650
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT3822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer