Basic Information
| Provider Information | |||||||||
| NPI: | 1831500974 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EPIC PEDIATRIC THERAPY, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14515 BRIARHILLS PKWY | ||||||||
| Address2: | STE. 208 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770771000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139793800 | ||||||||
| FaxNumber: | 7139793806 | ||||||||
| Practice Location | |||||||||
| Address1: | 14515 BRIARHILLS PKWY | ||||||||
| Address2: | STE. 208 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770771000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139793800 | ||||||||
| FaxNumber: | 7139793806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2014 | ||||||||
| LastUpdateDate: | 05/12/2014 | ||||||||
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| AuthorizedOfficialLastName: | GONZALE | ||||||||
| AuthorizedOfficialFirstName: | MAGGIE | ||||||||
| AuthorizedOfficialMiddleName: | REEVES | ||||||||
| AuthorizedOfficialTitleorPosition: | SPEECH-LANGUAGE PATHOLOGIST ASSISTA | ||||||||
| AuthorizedOfficialTelephone: | 2105108944 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0700X | 37585 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech |
No ID Information.