Provider Demographics
NPI:1134323215
Name:LEACHMAN, GRETCHEN A (DPT)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:A
Last Name:LEACHMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:L
Other - Last Name:COLWILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4155 MOORPARK AVE.
Mailing Address - Street 2:SUITE 20
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1597
Mailing Address - Country:US
Mailing Address - Phone:408-615-1516
Mailing Address - Fax:866-754-1516
Practice Address - Street 1:4155 MOORPARK AVE.
Practice Address - Street 2:SUTIE 20
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1597
Practice Address - Country:US
Practice Address - Phone:408-615-1516
Practice Address - Fax:866-754-1516
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26728225100000X, 2251X0800X
CAPT267282251G0304X, 2251N0400X, 2251S0007X
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic