Provider Demographics
NPI:1619417656
Name:LABRADA, MIGUEL (PT, DPT, PTA)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:LABRADA
Suffix:
Gender:M
Credentials:PT, DPT, PTA
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:LABRADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4109 N ARMENIA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6411
Mailing Address - Country:US
Mailing Address - Phone:813-588-3342
Mailing Address - Fax:813-588-3602
Practice Address - Street 1:4109 N ARMENIA AVE STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6411
Practice Address - Country:US
Practice Address - Phone:813-588-3342
Practice Address - Fax:813-588-3602
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT339012251X0800X, 2251G0304X, 2251X0800X
CAPT2922662251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics