Provider Demographics
NPI:1073631008
Name:LABELLE, BRIAN LEONARD (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:LEONARD
Last Name:LABELLE
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 1:1 CHESTNUT CT
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1732
Mailing Address - Country:US
Mailing Address - Phone:203-458-1142
Mailing Address - Fax:
Practice Address - Street 1:38 TALMADGE AVE
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-3541
Practice Address - Country:US
Practice Address - Phone:203-469-2316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004598314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility