Provider Demographics
NPI:1508045824
Name:ACTION KIDS REHABILITATION PC
Entity Type:Organization
Organization Name:ACTION KIDS REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:TICE
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:956-428-8951
Mailing Address - Street 1:PO BOX 532047
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-2047
Mailing Address - Country:US
Mailing Address - Phone:956-428-8951
Mailing Address - Fax:956-428-0232
Practice Address - Street 1:5901 MCPHERSON RD
Practice Address - Street 2:SUITE 9-B
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6173
Practice Address - Country:US
Practice Address - Phone:956-753-5437
Practice Address - Fax:956-726-4465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty