Provider Demographics
NPI:1285190090
Name:LABRIOLA, KARIN LYNN (PTA)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:LYNN
Last Name:LABRIOLA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16376 CELTIC CIR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:IL
Mailing Address - Zip Code:60442-6104
Mailing Address - Country:US
Mailing Address - Phone:309-737-0241
Mailing Address - Fax:
Practice Address - Street 1:14230 KILPATRICK AVE
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60418-2399
Practice Address - Country:US
Practice Address - Phone:708-293-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-17
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.004387225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant