Provider Demographics
NPI:1295976132
Name:UYLENBROECK, JOHAN JULES (PT, MBA, CLT, LSVT)
Entity type:Individual
Prefix:MR
First Name:JOHAN
Middle Name:JULES
Last Name:UYLENBROECK
Suffix:
Gender:M
Credentials:PT, MBA, CLT, LSVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253-5710
Mailing Address - Country:US
Mailing Address - Phone:603-366-8508
Mailing Address - Fax:
Practice Address - Street 1:319 E DUNSTABLE RD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-4207
Practice Address - Country:US
Practice Address - Phone:603-273-6459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0003053225100000X
NH1918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist