Provider Demographics
NPI:1265567937
Name:LABRANCHE, LEOPOLD ROGER (PT)
Entity type:Individual
Prefix:MR
First Name:LEOPOLD
Middle Name:ROGER
Last Name:LABRANCHE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 E THRUSH LN
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7710
Mailing Address - Country:US
Mailing Address - Phone:928-526-2987
Mailing Address - Fax:
Practice Address - Street 1:3909 E THRUSH LN
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-7710
Practice Address - Country:US
Practice Address - Phone:928-526-2987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34322251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic