Provider Demographics
NPI:1780891416
Name:LABIAL, LOUIE DELA PENA (PT)
Entity type:Individual
Prefix:
First Name:LOUIE
Middle Name:DELA PENA
Last Name:LABIAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6850 BROCKTON AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3808
Mailing Address - Country:US
Mailing Address - Phone:951-774-4611
Mailing Address - Fax:951-276-3597
Practice Address - Street 1:399 E HIGHLAND AVE
Practice Address - Street 2:SUITE 409
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3808
Practice Address - Country:US
Practice Address - Phone:909-881-8612
Practice Address - Fax:808-881-8372
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 33636OtherLICENSE
CAPT 33636OtherLICENSE