Provider Demographics
NPI:1093152365
Name:LABAUGH, ELIZABETH FRENCH (BS, LMT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FRENCH
Last Name:LABAUGH
Suffix:
Gender:F
Credentials:BS, LMT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:LABAUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS, LMT
Mailing Address - Street 1:295 WATER ST
Mailing Address - Street 2:SUITE 219
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-4619
Mailing Address - Country:US
Mailing Address - Phone:207-621-2690
Mailing Address - Fax:207-621-2690
Practice Address - Street 1:295 WATER ST
Practice Address - Street 2:SUITE 219
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4619
Practice Address - Country:US
Practice Address - Phone:207-621-2690
Practice Address - Fax:207-621-2690
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT092172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMT092OtherMAINE STATE LICENSE