Healthcare Provider Details

I. General information

NPI: 1689817744
Provider Name (Legal Business Name): LEAPS AND BOUNDS PEDIATRIC THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2009
Last Update Date: 11/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 BAIR AVE SUITE 107
LINCOLN NE
68504-1183
US

IV. Provider business mailing address

4640 BAIR AVE SUITE 107
LINCOLN NE
68504-1183
US

V. Phone/Fax

Practice location:
  • Phone: 402-742-7400
  • Fax: 402-742-9592
Mailing address:
  • Phone: 402-742-7400
  • Fax: 402-742-9592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number290
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1416
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2418
License Number StateNE

VIII. Authorized Official

Name: MRS. BRANDY M ESCAMILLA
Title or Position: VICE PRESIDENT/SECRETARY
Credential: DPT
Phone: 402-742-7400