Provider Demographics
NPI:1003699067
Name:LEAPS & BOUNDS DEVELOPMENTAL THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:LEAPS & BOUNDS DEVELOPMENTAL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DEVELOPMENTAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MANGRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-971-2230
Mailing Address - Street 1:9445 INDIANAPOLIS BLVD # 1223
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2648
Mailing Address - Country:US
Mailing Address - Phone:773-971-2230
Mailing Address - Fax:
Practice Address - Street 1:9445 INDIANAPOLIS BLVD # 1223
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2648
Practice Address - Country:US
Practice Address - Phone:773-971-2230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency