Provider Demographics
NPI:1679610976
Name:LABISCH, THOMAS JOHN (DPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:LABISCH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 W MEQUON RD
Mailing Address - Street 2:STE 201
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3264
Mailing Address - Country:US
Mailing Address - Phone:262-241-8402
Mailing Address - Fax:262-241-8403
Practice Address - Street 1:1516 W MEQUON RD
Practice Address - Street 2:STE 201
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3264
Practice Address - Country:US
Practice Address - Phone:262-241-8402
Practice Address - Fax:262-241-8403
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3460024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0000464150001Medicare ID - Type Unspecified