Provider Demographics
NPI:1619417656
Name:LABRADA, MIGUEL (PT, DPT, PTA)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:LABRADA
Suffix:
Gender:M
Credentials:PT, DPT, PTA
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:LABRADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:650 S SPRING ST APT 403
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90014-1957
Mailing Address - Country:US
Mailing Address - Phone:305-772-1052
Mailing Address - Fax:
Practice Address - Street 1:6424 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-5712
Practice Address - Country:US
Practice Address - Phone:305-772-1052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33901225100000X, 2251G0304X, 2251X0800X
CAPT2922662251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics