Provider Demographics
NPI:1023838059
Name:ENGLEBRETSON, GEORGE MATTHEW (NCLMBT)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:MATTHEW
Last Name:ENGLEBRETSON
Suffix:
Gender:M
Credentials:NCLMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 MOURNING DOVE TER
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-9129
Mailing Address - Country:US
Mailing Address - Phone:336-479-4419
Mailing Address - Fax:
Practice Address - Street 1:308 MOURNING DOVE TER
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-9129
Practice Address - Country:US
Practice Address - Phone:336-479-4419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20225225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist