Provider Demographics
NPI:1093842726
Name:LABORDE, LINDA A (PT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:LABORDE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:A
Other - Last Name:GALLERANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2300 N MAYFAIR RD
Mailing Address - Street 2:SUITE 555
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1505
Mailing Address - Country:US
Mailing Address - Phone:414-302-0770
Mailing Address - Fax:
Practice Address - Street 1:2300 N MAYFAIR RD
Practice Address - Street 2:SUITE 555
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1505
Practice Address - Country:US
Practice Address - Phone:414-302-0770
Practice Address - Fax:414-302-0775
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4101208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation