Provider Demographics
NPI:1407282734
Name:EPIC PT HEALTH & PERFORMANCE LLC
Entity Type:Organization
Organization Name:EPIC PT HEALTH & PERFORMANCE LLC
Other - Org Name:EPIC PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHDUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-223-1594
Mailing Address - Street 1:5006 CENTER ST STE N
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-2314
Mailing Address - Country:US
Mailing Address - Phone:253-476-3333
Mailing Address - Fax:253-476-3334
Practice Address - Street 1:5006 CENTER ST STE N
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-2314
Practice Address - Country:US
Practice Address - Phone:253-476-3333
Practice Address - Fax:253-476-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603331038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty