Provider Demographics
NPI:1548228067
Name:LABARRE, TANYA MARIE-HELENE (MPT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:MARIE-HELENE
Last Name:LABARRE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:MARIE-HELENE
Other - Last Name:CARDILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:4040 ORCHARD ST W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6606
Mailing Address - Country:US
Mailing Address - Phone:253-564-1560
Mailing Address - Fax:253-564-4449
Practice Address - Street 1:4060 WHEATON WAY
Practice Address - Street 2:SUITE C
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3500
Practice Address - Country:US
Practice Address - Phone:360-479-8477
Practice Address - Fax:360-479-8417
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8341992Medicaid
S99767Medicare UPIN
WAGAB13918Medicare PIN
WAAB13917Medicare ID - Type Unspecified