Provider Demographics
NPI:1336472018
Name:ALBURO, RENATO M (PT)
Entity Type:Individual
Prefix:MR
First Name:RENATO
Middle Name:M
Last Name:ALBURO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 N AUDUBON PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250
Mailing Address - Country:US
Mailing Address - Phone:347-405-3592
Mailing Address - Fax:
Practice Address - Street 1:3230 N AUDUBON PARK RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-7820
Practice Address - Country:US
Practice Address - Phone:347-405-3592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005559A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000639798OtherBLUE CROSS BLUE SHIELD
IN000000641772OtherBLUE CROSS BLUE SHIEL