MEDICARE: MS. MICHELE JACQUELINE EPPS PT

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	20645	MD

General Provider Information

NPI Number	:	1033232954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELE JACQUELINE EPPS PT

Provider Business Mailing Address
First Line	:	2226 FOXBANE SQ
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-4608
Country	:	US
Telephone Number	:	410-601-0261
Fax Number	:

Provider Business Practice Location Address
First Line	:	14502 GREENVIEW DR
Second Line	:	ST. 406
City	:	LAUREL
State	:	MD
Zip	:	20708-3287
Country	:	US
Telephone Number	:	301-362-0114
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/08/2007

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