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NPI Code Detail

MEDICARE: LEAPS AND BOUNDS PT

MEDICARE: LEAPS AND BOUNDS PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251P0200XPediatric Physical Therapist024532-1NY

General Provider Information

NPI Number : 1386927291
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEAPS AND BOUNDS PT
Provider Business Mailing Address
First Line : 2460 VICTORY BLVD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-6612
Country : US
Telephone Number : 718-477-1911
Fax Number : 718-477-1971
Provider Business Practice Location Address
First Line : 2460 VICTORY BLVD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-6612
Country : US
Telephone Number : 718-477-1911
Fax Number : 718-477-1971
Authorized Official
Title or Position : OWNER/PHYSICAL THERAPIST
Name : DR. JILL KISSEL
Credential : BS, MPT, DPT
Telephone Number : 718-477-1911
Provider Enumeration Date : 09/27/2011
Last Update Date : 09/27/2011

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Directions to “LEAPS AND BOUNDS PT ” Practice Location

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