Provider Demographics
NPI:1235771825
Name:LABRADOR, RALARDO MEJIAS (LPTA)
Entity Type:Individual
Prefix:MR
First Name:RALARDO
Middle Name:MEJIAS
Last Name:LABRADOR
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7363 KINGSPORT LN
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-7495
Mailing Address - Country:US
Mailing Address - Phone:240-308-3636
Mailing Address - Fax:
Practice Address - Street 1:7363 KINGSPORT LN
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-7495
Practice Address - Country:US
Practice Address - Phone:240-308-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2145433225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant