Provider Demographics
NPI:1750502837
Name:LIBOVE, LAURA G
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:G
Last Name:LIBOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 SOUTHWIND WAY
Mailing Address - Street 2:
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1025
Mailing Address - Country:US
Mailing Address - Phone:215-643-5961
Mailing Address - Fax:
Practice Address - Street 1:2002 JOSHUA RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-2430
Practice Address - Country:US
Practice Address - Phone:610-260-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA002364L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist