Provider Demographics
NPI:1689817744
Name:LEAPS AND BOUNDS PEDIATRIC THERAPY, P.C.
Entity Type:Organization
Organization Name:LEAPS AND BOUNDS PEDIATRIC THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ESCAMILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:402-742-7400
Mailing Address - Street 1:4640 BAIR AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-1183
Mailing Address - Country:US
Mailing Address - Phone:402-742-7400
Mailing Address - Fax:402-742-9592
Practice Address - Street 1:4640 BAIR AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-1183
Practice Address - Country:US
Practice Address - Phone:402-742-7400
Practice Address - Fax:402-742-9592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-19
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24182251X0800X
NE1416225XP0200X
NE290235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026285000-OTMedicaid
NE10026284900-STMedicaid
NE10026285100-PTMedicaid