Healthcare Provider Details

I. General information

NPI: 1760074975
Provider Name (Legal Business Name): MADELINE ASHLEY JEPSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10640 N RIVERSIDE DR STE 200
FORT WORTH TX
76244-9506
US

IV. Provider business mailing address

10640 N RIVERSIDE DR STE 200
FORT WORTH TX
76244-9506
US

V. Phone/Fax

Practice location:
  • Phone: 817-431-9000
  • Fax:
Mailing address:
  • Phone: 972-571-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1341960
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: