MEDICARE: BRETT ALAN TICE PT

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	1115756	TX

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	86657T	OTHER		BCBS

General Provider Information

NPI Number	:	1780690024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT ALAN TICE PT

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	:	1801 N ED CAREY DR STE C
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78550-8281
Country	:	US
Telephone Number	:	956-428-8951
Fax Number	:	956-428-0232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	03/05/2009

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Directions to “ BRETT ALAN TICE PT” Practice Location

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