Provider Demographics
NPI:1013901867
Name:LABARGE, SUSAN H (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:H
Last Name:LABARGE
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 1:179 TOM MILLER RD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6424
Mailing Address - Country:US
Mailing Address - Phone:518-563-9471
Mailing Address - Fax:518-563-9488
Practice Address - Street 1:179 TOM MILLER RD
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6424
Practice Address - Country:US
Practice Address - Phone:518-563-9471
Practice Address - Fax:518-563-9488
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02261654Medicaid
NYR57007Medicare UPIN
NYCC1817Medicare ID - Type Unspecified