Provider Demographics
NPI:1154354934
Name:LABOITEAUX, LAURA LEIGH (MPT)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LEIGH
Last Name:LABOITEAUX
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 NORTHERN AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2847
Mailing Address - Country:US
Mailing Address - Phone:301-745-8915
Mailing Address - Fax:301-745-8916
Practice Address - Street 1:580 NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2847
Practice Address - Country:US
Practice Address - Phone:301-745-8915
Practice Address - Fax:301-745-8916
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412893100Medicaid
MDP00222631OtherMEDICARE RAILROAD
MD412893100Medicaid
MD960MMedicare PIN