Healthcare Provider Details

I. General information

NPI: 1962033514
Provider Name (Legal Business Name): GAINING GROUND THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CHESTNUT ST
MONTCLAIR NJ
07042-2943
US

IV. Provider business mailing address

115 CHESTNUT ST
MONTCLAIR NJ
07042-2943
US

V. Phone/Fax

Practice location:
  • Phone: 862-202-9003
  • Fax:
Mailing address:
  • Phone: 862-202-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. JANNIKA HANTHO
Title or Position: OWNER
Credential:
Phone: 862-202-9003