Healthcare Provider Details

I. General information

NPI: 1144285768
Provider Name (Legal Business Name): ANGELA LABELLA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 BLOOMFIELD AVE 2ND FLOOR
BLOOMFIELD CT
06002-2489
US

IV. Provider business mailing address

693 BLOOMFIELD AVE 2ND FLOOR
BLOOMFIELD CT
06002-2489
US

V. Phone/Fax

Practice location:
  • Phone: 860-242-8427
  • Fax: 860-242-4147
Mailing address:
  • Phone: 860-242-8427
  • Fax: 860-242-4147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2354
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier080002354CT09
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerANTHEM BC/BS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: