Provider Demographics
NPI:1821285651
Name:LABOU, JORGEANNE SURGEE (PT)
Entity Type:Individual
Prefix:
First Name:JORGEANNE
Middle Name:SURGEE
Last Name:LABOU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PLEASANT HILL AVE N
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3104
Mailing Address - Country:US
Mailing Address - Phone:707-829-3282
Mailing Address - Fax:707-829-3287
Practice Address - Street 1:100 PLEASANT HILL AVE N
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3104
Practice Address - Country:US
Practice Address - Phone:707-829-3282
Practice Address - Fax:707-829-3287
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist