Provider Demographics
NPI:1255410494
Name:LABADIE, AMY E (PT, DPT, CSCS)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:E
Last Name:LABADIE
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:227 WADSWORTH DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-4510
Practice Address - Country:US
Practice Address - Phone:804-323-7874
Practice Address - Fax:804-323-7879
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052042052251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00761605OtherRR MEDICARE
VAC05954OtherMEDICARE GROUP PTAN
VA1255410494Medicaid
VA018856W25Medicare PIN
VAC05954OtherMEDICARE GROUP PTAN
VAP00761605OtherRR MEDICARE
VA496628Medicare ID - Type Unspecified