MEDICARE: EL PASO PEDIATRIC THERAPY SERVICES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	235Z00000X	Speech-Language Pathologist
3	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1245640796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL PASO PEDIATRIC THERAPY SERVICES, LLC

Provider Business Mailing Address
First Line	:	3800 N MESA ST
Second Line	:	A-2 #410
City	:	EL PASO
State	:	TX
Zip	:	79902-1538
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 N MESA ST
Second Line	:	C-7
City	:	EL PASO
State	:	TX
Zip	:	79902-1538
Country	:	US
Telephone Number	:	915-637-4787
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MARTHA A DODSON
Credential	:	D.O.
Telephone Number	:	915-637-4787

Provider Enumeration Date	:	05/06/2014
Last Update Date	:	05/06/2014

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Directions to “EL PASO PEDIATRIC THERAPY SERVICES, LLC ” Practice Location

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