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NPI Code Detail

MEDICARE: EPIC PEDIATRIC THERAPY, LP.

MEDICARE: EPIC PEDIATRIC THERAPY, LP.
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
1261QR0401XComprehensive Outpatient Rehabilitation Facility (CORF)
2261QR0400XRehabilitation Clinic/Center67-6535TX

General Provider Information

NPI Number : 1013163377
Entity Type Code : Organization
Provider Name (Legal Business Name) : EPIC PEDIATRIC THERAPY, LP.
Provider Business Mailing Address
First Line : 400 INTERSTATE NORTH PKWY SE STE 1600
Second Line :
City : ATLANTA
State : GA
Zip : 30339-5047
Country : US
Telephone Number : 470-464-8000
Fax Number :
Provider Business Practice Location Address
First Line : 1351 E BARDIN RD STE 160
Second Line :
City : ARLINGTON
State : TX
Zip : 76018-2137
Country : US
Telephone Number : 177-951-2918
Fax Number : 817-698-9506
Authorized Official
Title or Position : CFO
Name : MATTHEW BUCKHALTER
Credential :
Telephone Number : 470-464-8000
Provider Enumeration Date : 08/18/2008
Last Update Date : 01/27/2025

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