MEDICARE: EAGLE PASS THERAPY CLINIC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	86MR	OTHER		BCBS

General Provider Information

NPI Number	:	1578579827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE PASS THERAPY CLINIC PC

Provider Business Mailing Address
First Line	:	PO BOX 532127
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78553
Country	:	US
Telephone Number	:	956-428-8951
Fax Number	:	956-428-0232

Provider Business Practice Location Address
First Line	:	1000 CROWN RIDGE BLVD
Second Line	:	SUITE C
City	:	EAGLE PASS
State	:	TX
Zip	:	78852
Country	:	US
Telephone Number	:	830-757-2497
Fax Number	:	830-757-0489

Authorized Official
Title or Position	:	DIRECTOR
Name	:	BRETT ALAN TICE
Credential	:
Telephone Number	:	956-428-8951

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	01/05/2026

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