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General NPI Number Information
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NPI Number | 1700400645
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Entity Type | Organization
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Legal Business Name | BIG LEAP THERAPY CENTER
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Dates
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Enumeration Date | 06/06/2020
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 8350 NW 52ND TER STE 301
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City | DORAL
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State | FL
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Zip | 33166-7708
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Country | US
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Telephone | 954-610-5070
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Fax |
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Provider Business Mailing Address
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Address Line | 12485 SW 137TH AVE STE 211
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City | MIAMI
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State | FL
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Zip | 33186-4217
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KARLA MEDRANDA
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Credential |
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Telephone | 305-798-0214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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