Healthcare Provider Details

I. General information

NPI: 1528997301
Provider Name (Legal Business Name): DYLAN PLANTZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MARLBOROUGH RD
SHALIMAR FL
32579-1039
US

IV. Provider business mailing address

5 MARLBOROUGH RD
SHALIMAR FL
32579-1039
US

V. Phone/Fax

Practice location:
  • Phone: 850-585-8641
  • Fax:
Mailing address:
  • Phone: 850-585-8641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT44646
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: