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General NPI Number Information
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NPI Number | 1619478872
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Entity Type | Individual
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Provider Name | AMANDA LABA
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Gender | Female
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Dates
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Enumeration Date | 02/23/2018
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 468 CADIEUX RD
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City | GROSSE POINTE
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State | MI
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Zip | 48230-1507
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Country | US
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Telephone | 947-523-4080
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Fax |
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Provider Business Mailing Address
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Address Line | 6550 STARVILLE RD
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City | COTTRELLVILLE
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State | MI
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Zip | 48039-1810
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501015847
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License Number State | MI
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