Provider Demographics
NPI:1831500974
Name:EPIC PEDIATRIC THERAPY, LP
Entity Type:Organization
Organization Name:EPIC PEDIATRIC THERAPY, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST ASSISTA
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:REEVES
Authorized Official - Last Name:GONZALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-510-8944
Mailing Address - Street 1:14515 BRIARHILLS PKWY
Mailing Address - Street 2:STE. 208
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-1000
Mailing Address - Country:US
Mailing Address - Phone:713-979-3800
Mailing Address - Fax:713-979-3806
Practice Address - Street 1:14515 BRIARHILLS PKWY
Practice Address - Street 2:STE. 208
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-1000
Practice Address - Country:US
Practice Address - Phone:713-979-3800
Practice Address - Fax:713-979-3806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37585261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech