Provider Demographics
NPI:1164728937
Name:LABIB, RENEE TALAAT ISHAK (RPT, CLT)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:TALAAT ISHAK
Last Name:LABIB
Suffix:
Gender:F
Credentials:RPT, CLT
Other - Prefix:
Other - First Name:ERINY
Other - Middle Name:
Other - Last Name:YOUSSOF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28051 DEQUINDRE ROAD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071
Mailing Address - Country:US
Mailing Address - Phone:313-584-4625
Mailing Address - Fax:313-584-5676
Practice Address - Street 1:5445 OAKMAN BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126
Practice Address - Country:US
Practice Address - Phone:313-584-4625
Practice Address - Fax:313-584-5676
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014337208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation