Provider Demographics
NPI:1386854453
Name:MILBERN, JARROD L (CRT)
Entity Type:Individual
Prefix:
First Name:JARROD
Middle Name:L
Last Name:MILBERN
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 BUENA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4311
Mailing Address - Country:US
Mailing Address - Phone:806-352-0975
Mailing Address - Fax:
Practice Address - Street 1:1120 BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4311
Practice Address - Country:US
Practice Address - Phone:806-352-0975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified