Provider Demographics
NPI:1790983096
Name:LABANG, JENNIFER SOBERANO (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:SOBERANO
Last Name:LABANG
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 N GATE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-1247
Mailing Address - Country:US
Mailing Address - Phone:302-690-7158
Mailing Address - Fax:
Practice Address - Street 1:2506 N GATE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-1247
Practice Address - Country:US
Practice Address - Phone:302-690-7158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10001097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist