Provider Demographics
NPI:1770196800
Name:LABELLA, LISAMARIE
Entity type:Individual
Prefix:
First Name:LISAMARIE
Middle Name:
Last Name:LABELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5915 HOLLIS ST STE A
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2066
Mailing Address - Country:US
Mailing Address - Phone:510-923-0700
Mailing Address - Fax:510-923-0500
Practice Address - Street 1:5915 HOLLIS ST STE A
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2066
Practice Address - Country:US
Practice Address - Phone:510-923-0700
Practice Address - Fax:510-923-0500
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist