Provider Demographics
NPI:1497374367
Name:LEAP PEDIATRIC THERAPY AND SPORTS MEDICINE PLLC
Entity Type:Organization
Organization Name:LEAP PEDIATRIC THERAPY AND SPORTS MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:443-286-3937
Mailing Address - Street 1:700 SW 78TH AVE APT 423
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3372
Mailing Address - Country:US
Mailing Address - Phone:443-286-3937
Mailing Address - Fax:
Practice Address - Street 1:700 SW 78TH AVE APT 423
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3372
Practice Address - Country:US
Practice Address - Phone:443-286-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy