Healthcare Provider Details

I. General information

NPI: 1063720316
Provider Name (Legal Business Name): WAEL A LABIB PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 20TH STREET
BELLEAIR BEACH FL
33786
US

IV. Provider business mailing address

101 20TH STREET
BELLEAIR BEACH FL
33786
US

V. Phone/Fax

Practice location:
  • Phone: 727-504-2905
  • Fax:
Mailing address:
  • Phone: 727-504-2905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10398
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: