Provider Demographics
NPI:1265547772
Name:LABRECQUE, SARAH W (PT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:W
Last Name:LABRECQUE
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 1:3915 8TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-1701
Mailing Address - Country:US
Mailing Address - Phone:941-747-7741
Mailing Address - Fax:941-747-1431
Practice Address - Street 1:3915 8TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-1701
Practice Address - Country:US
Practice Address - Phone:941-747-7741
Practice Address - Fax:941-747-1431
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY4566AMedicare PIN