Healthcare Provider Details

I. General information

NPI: 1063003127
Provider Name (Legal Business Name): LEANNA MOHOLLEN PT, DPT, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEANNA GEARHART

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 N RTE 17
PARAMUS NJ
07652-3117
US

IV. Provider business mailing address

31 E 32ND ST FL 4
NEW YORK NY
10016-5595
US

V. Phone/Fax

Practice location:
  • Phone: 201-808-2250
  • Fax:
Mailing address:
  • Phone: 212-759-2282
  • Fax: 212-379-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02002600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number046874
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: