Provider Demographics
NPI:1407174980
Name:LEAPS AND BOUNDS PEDIATRIC PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:LEAPS AND BOUNDS PEDIATRIC PHYSICAL THERAPY INC
Other - Org Name:LEAPS AND BOUNDS PEDIATRIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:DANAE
Authorized Official - Last Name:SANDERS-HOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:951-340-0431
Mailing Address - Street 1:PO BOX 6604
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-8053
Mailing Address - Country:US
Mailing Address - Phone:951-340-0431
Mailing Address - Fax:951-893-5135
Practice Address - Street 1:4211 VALLEY VIEW AVE
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3502
Practice Address - Country:US
Practice Address - Phone:951-340-0431
Practice Address - Fax:951-893-5135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty