Provider Demographics
NPI:1578178372
Name:LEAHY, CAROLINE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:LEAHY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 RIDGEDALE AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-2109
Mailing Address - Country:US
Mailing Address - Phone:973-359-0777
Mailing Address - Fax:973-359-0778
Practice Address - Street 1:120 EAGLE ROCK AVE STE 290
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-3168
Practice Address - Country:US
Practice Address - Phone:973-535-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01929000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist