Provider Demographics
NPI:1194823997
Name:DURBIN, REGINA WHITE (PT)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:WHITE
Last Name:DURBIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12935 SHELBYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1592
Mailing Address - Country:US
Mailing Address - Phone:502-489-5002
Mailing Address - Fax:502-489-8002
Practice Address - Street 1:12935 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1592
Practice Address - Country:US
Practice Address - Phone:502-489-5002
Practice Address - Fax:502-489-8002
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000718OtherLICENSE #