Provider Demographics
NPI:1659985745
Name:LABRA, BRYLLE JOSEPH SEBIAL (PT)
Entity Type:Individual
Prefix:
First Name:BRYLLE JOSEPH
Middle Name:SEBIAL
Last Name:LABRA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 6TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-1861
Mailing Address - Country:US
Mailing Address - Phone:669-213-8967
Mailing Address - Fax:
Practice Address - Street 1:1880 37TH ST STE 1
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6594
Practice Address - Country:US
Practice Address - Phone:772-213-9596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist