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General NPI Number Information
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NPI Number | 1700256708
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Entity Type | Organization
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Legal Business Name | BIG LEAPS
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Dates
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Enumeration Date | 10/02/2015
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Last Update Date | 11/16/2015
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Provider Practice Location Address
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Address Line | 999 SUMMER ST SUITE 104
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City | STAMFORD
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State | CT
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Zip | 06905-5546
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Country | US
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Telephone | 203-614-9382
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Fax |
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Provider Business Mailing Address
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Address Line | 999 SUMMER ST SUITE 104
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City | STAMFORD
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State | CT
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Zip | 06905-5546
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Country | US
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Telephone | 203-614-9382
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | SNEHA GOSALIA
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Credential | PT DPT
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Telephone | 203-614-9382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 004435
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 009183
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License Number State | CT
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