Healthcare Provider Details

I. General information

NPI: 1285469726
Provider Name (Legal Business Name): DYLAN JOSEPH LEBLANC DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/28/2026
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 SUNSET BLVD N STE 108
SUNSET BEACH NC
28468-5610
US

IV. Provider business mailing address

690 SUNSET BLVD N STE 108
SUNSET BEACH NC
28468-5610
US

V. Phone/Fax

Practice location:
  • Phone: 910-575-2775
  • Fax: 910-575-2776
Mailing address:
  • Phone: 910-575-2775
  • Fax: 910-575-2776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP060232T
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: