MEDICARE: MRS. AMY E LABADIE PT, DPT, CSCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	2305204205	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00761605	OTHER	VA	RR MEDICARE
2	C05954	OTHER	VA	MEDICARE GROUP PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255410494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY E LABADIE PT, DPT, CSCS

Provider Business Mailing Address
First Line	:	PO BOX 69030
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-9030
Country	:	US
Telephone Number	:	757-873-2302
Fax Number	:	757-873-2306

Provider Business Practice Location Address
First Line	:	227 WADSWORTH DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-4510
Country	:	US
Telephone Number	:	804-323-7874
Fax Number	:	804-323-7879

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	04/19/2018

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