Provider Demographics
NPI:1053069229
Name:LABRADA, GABRIEL (PTA28932)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:LABRADA
Suffix:
Gender:M
Credentials:PTA28932
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8857 SW 172ND AVE APT 112
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2989
Mailing Address - Country:US
Mailing Address - Phone:305-804-2438
Mailing Address - Fax:
Practice Address - Street 1:8857 SW 172ND AVE APT 112
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-2989
Practice Address - Country:US
Practice Address - Phone:305-804-2438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA28932225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty