Provider Demographics
NPI:1285469726
Name:LEBLANC, DYLAN JOSEPH (DPT)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:JOSEPH
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 AUGER ST APT 2
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01518-1151
Mailing Address - Country:US
Mailing Address - Phone:978-998-9262
Mailing Address - Fax:
Practice Address - Street 1:242 STURBRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-5327
Practice Address - Country:US
Practice Address - Phone:508-248-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPTL27951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist