Provider Demographics
NPI:1205023066
Name:EPIC PEDIATRIC THERAPY, LP
Entity Type:Organization
Organization Name:EPIC PEDIATRIC THERAPY, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-602-8218
Mailing Address - Street 1:5220 SPRING VALLEY RD
Mailing Address - Street 2:400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-3099
Mailing Address - Country:US
Mailing Address - Phone:214-431-4451
Mailing Address - Fax:214-466-1378
Practice Address - Street 1:305 NE LOOP 820
Practice Address - Street 2:SUITE 200
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-7209
Practice Address - Country:US
Practice Address - Phone:817-602-8218
Practice Address - Fax:817-900-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
TX013311251E00000X
TX015477251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty