Provider Demographics
NPI:1093355414
Name:LEAPS AND BOUNDS PEDIATRICTHERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:LEAPS AND BOUNDS PEDIATRICTHERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:256-235-2524
Mailing Address - Street 1:1703 LEIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-3832
Mailing Address - Country:US
Mailing Address - Phone:256-235-2524
Mailing Address - Fax:
Practice Address - Street 1:1703 LEIGHTON AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-3832
Practice Address - Country:US
Practice Address - Phone:256-235-2524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-46493OtherBCBS
AL890023650Medicaid