Provider Demographics
NPI:1063003127
Name:MOHOLLEN, LEANNA (PT, DPT, MS)
Entity type:Individual
Prefix:
First Name:LEANNA
Middle Name:
Last Name:MOHOLLEN
Suffix:
Gender:F
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:LEANNA
Other - Middle Name:
Other - Last Name:GEARHART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:31 E 32ND ST FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5595
Mailing Address - Country:US
Mailing Address - Phone:212-759-2282
Mailing Address - Fax:212-379-2123
Practice Address - Street 1:776 N RTE 17
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3117
Practice Address - Country:US
Practice Address - Phone:201-808-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02002600225100000X
NY046874225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist