Healthcare Provider Details

I. General information

NPI: 1487201752
Provider Name (Legal Business Name): LEAPS AND BOUNDS PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 SPRINGSIDE DR
ELGIN IL
60124-8476
US

IV. Provider business mailing address

227 SPRINGSIDE DR
ELGIN IL
60124-8476
US

V. Phone/Fax

Practice location:
  • Phone: 773-930-5958
  • Fax: 888-958-4665
Mailing address:
  • Phone: 773-930-5958
  • Fax: 888-958-4665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANDREA LINNETTE GOLDIE
Title or Position: PRESIDENT
Credential: OTR/L
Phone: 773-930-5958