Provider Demographics
NPI:1760074975
Name:JEPSON, MADELINE ASHLEY (PT)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:ASHLEY
Last Name:JEPSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:507 MARLANDWOOD RD APT 222
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-3686
Mailing Address - Country:US
Mailing Address - Phone:972-571-1313
Mailing Address - Fax:
Practice Address - Street 1:8700 N TARRANT PKWY STE 113
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-8464
Practice Address - Country:US
Practice Address - Phone:817-498-8344
Practice Address - Fax:817-498-8702
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1341960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist