Healthcare Provider Details

I. General information

NPI: 1407174980
Provider Name (Legal Business Name): LEAPS AND BOUNDS PEDIATRIC PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 VALLEY VIEW AVE
NORCO CA
92860-3502
US

IV. Provider business mailing address

PO BOX 6604
NORCO CA
92860-8053
US

V. Phone/Fax

Practice location:
  • Phone: 951-340-0431
  • Fax: 951-893-5135
Mailing address:
  • Phone: 951-340-0431
  • Fax: 951-893-5135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: CASSANDRA DANAE SANDERS-HOLLY
Title or Position: DIRECTOR/OWNER
Credential: DPT
Phone: 951-340-0431