Provider Demographics
NPI:1851352439
Name:LIBBY, LAURA ANN (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:LIBBY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02351-2627
Mailing Address - Country:US
Mailing Address - Phone:781-792-0454
Mailing Address - Fax:
Practice Address - Street 1:1 COMPASS WAY
Practice Address - Street 2:SUITE 204
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333
Practice Address - Country:US
Practice Address - Phone:508-350-2920
Practice Address - Fax:508-350-2317
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist