Provider Demographics
NPI:1548242381
Name:LEAPS & BOUNDS PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:LEAPS & BOUNDS PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:PRICE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:803-796-7421
Mailing Address - Street 1:989 KNOX ABBOTT DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-3346
Mailing Address - Country:US
Mailing Address - Phone:803-796-7421
Mailing Address - Fax:803-796-7422
Practice Address - Street 1:989 KNOX ABBOTT DR
Practice Address - Street 2:SUITE 400
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033-3346
Practice Address - Country:US
Practice Address - Phone:803-796-7421
Practice Address - Fax:803-796-7422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24952251P0200X
SC42452251P0200X
SC1304225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4173Medicaid