Healthcare Provider Details

I. General information

NPI: 1013163377
Provider Name (Legal Business Name): EPIC PEDIATRIC THERAPY, LP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 E BARDIN RD STE 160
ARLINGTON TX
76018-2137
US

IV. Provider business mailing address

400 INTERSTATE NORTH PKWY SE STE 1600
ATLANTA GA
30339-5047
US

V. Phone/Fax

Practice location:
  • Phone: 177-951-2918
  • Fax: 817-698-9506
Mailing address:
  • Phone: 470-464-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number67-6535
License Number StateTX

VIII. Authorized Official

Name: MATTHEW BUCKHALTER
Title or Position: CFO
Credential:
Phone: 470-464-8000