Healthcare Provider Details

I. General information

NPI: 1619531829
Provider Name (Legal Business Name): LEANNA GUNN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 WASHINGTON RD
RYE NH
03870-2318
US

IV. Provider business mailing address

1018 N GUIGNARD DR
SUMTER SC
29150-2423
US

V. Phone/Fax

Practice location:
  • Phone: 603-964-8144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5064
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8939
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: