Provider Demographics
NPI:1629677190
Name:LABAUVE, BRITTANY ADELE (LMT)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ADELE
Last Name:LABAUVE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1396 FLANNAGAN CT
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-6941
Mailing Address - Country:US
Mailing Address - Phone:337-764-0500
Mailing Address - Fax:
Practice Address - Street 1:1396 FLANNAGAN CT
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-6941
Practice Address - Country:US
Practice Address - Phone:337-764-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-25
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0023709225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist