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NPI Code Detail

MEDICARE: DYLAN LECLAIR

MEDICARE: DYLAN LECLAIR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist30429MD

General Provider Information

NPI Number : 1174314900
Entity Type Code : Individual
Provider Name (Legal Business Name) : DYLAN LECLAIR
Provider Business Mailing Address
First Line : 12 PHEASANT RIDGE RD
Second Line :
City : TOWNSEND
State : MA
Zip : 01469-1200
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10803 FALLS RD
Second Line :
City : TIMONIUM
State : MD
Zip : 21093-4518
Country : US
Telephone Number : 978-424-5858
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2025
Last Update Date : 06/23/2025

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Directions to “ DYLAN LECLAIR ” Practice Location

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