MEDICARE: MAFFEO PEDIATRIC THERAPY MANAGEMENT, LLC

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	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist	1142636	TX

General Provider Information

NPI Number	:	1821383639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAFFEO PEDIATRIC THERAPY MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	555 ROUND ROCK WEST DR # D
Second Line	:	STE 160
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5052
Country	:	US
Telephone Number	:	512-244-6623
Fax Number	:	512-244-7758

Provider Business Practice Location Address
First Line	:	555 ROUND ROCK WEST DR # D
Second Line	:	STE 160
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5052
Country	:	US
Telephone Number	:	512-244-6623
Fax Number	:	512-244-7758

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LYNNE D MAFFEO
Credential	:	P.T.
Telephone Number	:	512-244-6623

Provider Enumeration Date	:	06/09/2011
Last Update Date	:	06/09/2011

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