Provider Demographics
NPI:1245331396
Name:LEAPS & BOUNDS PEDIATRIC REHABILITATION CENTER, INC.
Entity type:Organization
Organization Name:LEAPS & BOUNDS PEDIATRIC REHABILITATION CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PECHERO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-630-6300
Mailing Address - Street 1:1005 E NOLANA AVE
Mailing Address - Street 2:STE. C
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6101
Mailing Address - Country:US
Mailing Address - Phone:956-630-6300
Mailing Address - Fax:956-686-2942
Practice Address - Street 1:1005 E NOLANA AVE
Practice Address - Street 2:STE. C
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6101
Practice Address - Country:US
Practice Address - Phone:956-630-6300
Practice Address - Fax:956-686-2942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X, 2251P0200X, 225200000X, 225XP0200X, 2355S0801X, 235Z00000X, 225100000X, 225X00000X, 251E00000X, 261QR0401X
TX261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX34LVOtherBC/BS
TX167033301Medicaid
TX34LVOtherBC/BS