Provider Demographics
NPI:1780690024
Name:TICE, BRETT ALAN (PT)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:ALAN
Last Name:TICE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 532127
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553
Mailing Address - Country:US
Mailing Address - Phone:956-428-8951
Mailing Address - Fax:956-428-0232
Practice Address - Street 1:1801 N ED CAREY DR STE C
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8281
Practice Address - Country:US
Practice Address - Phone:956-428-8951
Practice Address - Fax:956-428-0232
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1115756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX087766401Medicaid
86657TOtherBCBS
86657TOtherBCBS