Healthcare Provider Details

I. General information

NPI: 1700256708
Provider Name (Legal Business Name): BIG LEAPS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 SUMMER ST SUITE 104
STAMFORD CT
06905-5546
US

IV. Provider business mailing address

999 SUMMER ST SUITE 104
STAMFORD CT
06905-5546
US

V. Phone/Fax

Practice location:
  • Phone: 203-614-9382
  • Fax:
Mailing address:
  • Phone: 203-614-9382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number009183
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number004435
License Number StateCT

VIII. Authorized Official

Name: SNEHA GOSALIA
Title or Position: PHYSICAL THERAPIST
Credential: PT DPT
Phone: 203-614-9382