MEDICARE: JOHANNES M VLAAR PT

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
1	225100000X	Physical Therapist	PT0008200	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y4487	OTHER	FL	BCBS OF FL

General Provider Information

NPI Number	:	1063518603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHANNES M VLAAR PT

Provider Business Mailing Address
First Line	:	1520 10TH AVE N STE B
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-2069
Country	:	US
Telephone Number	:	561-740-4555
Fax Number	:	866-248-3592

Provider Business Practice Location Address
First Line	:	1520 10TH AVE N STE B
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-2069
Country	:	US
Telephone Number	:	561-740-4555
Fax Number	:	866-248-3592

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/20/2020

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