MEDICARE: EPOCH PHYSICAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508445669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EPOCH PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 383
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32790-0383
Country	:	US
Telephone Number	:	407-879-2028
Fax Number	:

Provider Business Practice Location Address
First Line	:	2333 WESTMINSTER CT
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-3451
Country	:	US
Telephone Number	:	407-879-2028
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHELLE LYNN NELSON
Credential	:	DPT
Telephone Number	:	407-879-2028

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	05/10/2021

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