Provider Demographics
| NPI: | 1245331396 |
|---|---|
| Name: | LEAPS & BOUNDS PEDIATRIC REHABILITATION CENTER, INC. |
| Entity type: | Organization |
| Organization Name: | LEAPS & BOUNDS PEDIATRIC REHABILITATION CENTER, INC. |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | ADMINISTRATOR |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | ANGELA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | PECHERO |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | RN |
| Authorized Official - Phone: | 956-630-6300 |
| Mailing Address - Street 1: | 1005 E NOLANA AVE |
| Mailing Address - Street 2: | STE. C |
| Mailing Address - City: | MCALLEN |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 78504-6101 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 956-630-6300 |
| Mailing Address - Fax: | 956-686-2942 |
| Practice Address - Street 1: | 1005 E NOLANA AVE |
| Practice Address - Street 2: | STE. C |
| Practice Address - City: | MCALLEN |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 78504-6101 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 956-630-6300 |
| Practice Address - Fax: | 956-686-2942 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-09-25 |
| Last Update Date: | 2013-05-29 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 224Z00000X, 2251P0200X, 225200000X, 225XP0200X, 2355S0801X, 235Z00000X, 225100000X, 225X00000X, 251E00000X, 261QR0401X | ||
| TX | 261QR0401X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | Group - Multi-Specialty |
| No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
| No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
| No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
| No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
| No | 2355S0801X | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | Group - Multi-Specialty |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 251E00000X | Agencies | Home Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | 34LV | Other | BC/BS |
| TX | 167033301 | Medicaid | |
| TX | 34LV | Other | BC/BS |
