Healthcare Provider Details

I. General information

NPI: 1275081168
Provider Name (Legal Business Name): JEFFREY LEBLANC DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 MASSACHUSETTS AVE
BOSTON MA
02118-2605
US

IV. Provider business mailing address

811 MASSACHUSETTS AVE
BOSTON MA
02118-2605
US

V. Phone/Fax

Practice location:
  • Phone: 888-697-8123
  • Fax: 888-329-8678
Mailing address:
  • Phone: 888-697-8123
  • Fax: 888-329-8678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number22370
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: