Provider Demographics
NPI:1063518603
Name:VLAAR, JOHANNES M (PT)
Entity type:Individual
Prefix:
First Name:JOHANNES
Middle Name:M
Last Name:VLAAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 10TH AVE N STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-2069
Mailing Address - Country:US
Mailing Address - Phone:561-740-4555
Mailing Address - Fax:866-248-3592
Practice Address - Street 1:1520 10TH AVE N STE B
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-2069
Practice Address - Country:US
Practice Address - Phone:561-740-4555
Practice Address - Fax:866-248-3592
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0008200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY4487OtherBCBS OF FL
FLY4487OtherBCBS OF FL