Provider Demographics
NPI:1700267820
Name:LONGENECKER, LEANN (DPT)
Entity type:Individual
Prefix:
First Name:LEANN
Middle Name:
Last Name:LONGENECKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LEANN
Other - Middle Name:
Other - Last Name:HYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:955 W MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:MOUNT JOY
Practice Address - State:PA
Practice Address - Zip Code:17552-1838
Practice Address - Country:US
Practice Address - Phone:717-492-9532
Practice Address - Fax:717-492-9235
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT024557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030472460001Medicaid